Pacemaker Adjustments

Hi everyone. I'm 57 and fairly active. I just got my pacemaker implanted on April 24 (for an AV block Mobitz 2). I've definitely noticed a big improvement. However, I still experience "skipped" beats sometimes, usually when I'm doing something strenuous (going up stairs or working out). I also have started to experience light headedness if I get up abruptly. Do I need to have my pacemaker settings adjusted? If so, do you have any advice on what the settings should be? Thanks!


Skipped beats

by AgentX86 - 2019-05-30 07:29:20

These are most likely PACs or PVCs and are actually an additional, short, beat. If you could catch one while feeling your carotid artery,  you'd feel the extra "shallow" beat. You normally don't feel this because the heart hasn't had time to completely fill, so it's not strong, like a normal beat. These are almost always benign and may go away as your heart heals. It's been through a lot.

Light headed when standing quickly is also very normal. The cure for that is not to stand quickly. Take an extra couple of seconds. Are you on any new drugs? Many of them will exacerbate this.

Your PM settings will be unique to you. One setting I like is the nighttime rate change. I have mine drop from 80bpm to 50bpm from 12:00AM to 6:00AM. Makes sleeping easier (though DST screws with it). The downside is that ane exertion during this time is problematic.

Rate Response

by Swangirl - 2019-05-30 13:25:21

With a AV block you probably have a dual PM wih Rate Response.  When you are doing something strenuous rate response will kick in and match your heart rate.  It is triggered by foot strikes and upper body movement.  This setting is often difficult for your EP or rep to get right and you need to go back until it is adjusted to your satisfaction.  If you put "rate response" in the search line for this site you will get a lot more information.

Rate Response 2

by John@PC - 2019-05-30 19:15:37

I agree with Swangirl because what you describe is very familiar to my own experience.  Yes, they could be PAC's or PVC's but normally that wouldn't result in lightheadness.   On your next visit to the EP make sure you describe your symptoms in detail (how the palpatations "feel" and under what circumstances they occur).  Also ask him/her if it's possible you're experiencing "pacemaker syndrome" which is a catch-all for drops in blood pressure when you're being paced, most commonly in the ventricles.  Assuming you have an accelerometer sensor you may be able to recreate the symptoms by lightly "tapping" your PM to simulate activity.  A test I did multiple times was to take my BP while sitting, then after standing in place for a minute, then take ten fast steps (or better yet climb a flight of stairs) and repeat taking BP.  If you're sensitive to the Rate Response kicking in you will see a significant drop in BP after the walking/climbing and probably fell the "skipping" sensation as well as feeling lightheaded.  While this may or may not be the case in your situation I know that I had two EP's over 10 years that failed to tie my severe drops in BP to my intolerance to being paced in my lower chambers.  I can't recommend PM settings, but I strongly recommend that you tell your EP every detail so he can.  In my case turning off my rate response and lengthing AV delay made all the difference in the world.  Good luck.




Pacemaker Adjustments

by JohnGMD - 2019-05-30 23:17:22

Thanks for your comments. I will start checking my BP and do more research on rate response then talk to my EP. I would like to get back into hiking and backpacking and really need to get this just right. 


by Swangirl - 2019-05-30 23:49:04

The best adjustment I got that fixed almost all of my complaints was with the cardiologist and the St. Jude rep with me on the treadmill.  The doctor was watching my heart, the rep watching the PM and by conferring together they got it right.  I am 77 play racket sports, hike, and walk, and do circuit classes at the gym.  I am very happy with my rate response settings.  If I get a bit breathless, like John@PC said, I tap the device lightly or stamp my feet.  Our devices are very complicated and have many settings and it's up to us to work with our medical people to make them work they way we need them to.  

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