First Doctor visit after PM

This site is really helpful and I hope I’m not “ overusing “ the information found here !

On June 30th I have my first doctor visit since my PM was implanted. The Medtronic rep will be there as well. My doctor said they would “tweak” and “ fine tune” the PM.

. What kinds of questions do I need to ask ?? Other than occasional high BP ( 164/88) I’m getting along great and feel so much better.

i have LBBB and I believe I have two leads, one in top chamber and one in ventricle. He also said I have 1st degree heart block ( is that the same thing as LBBB ??) I want to be knowledge and educate myself beforehand.

Thanks in advance...


Fine Tuning

by Swangirl - 2020-06-12 18:32:45

There are a miriad of adjustments on these amazing technological devices and you want yours to do what you need it to do.  Have you tried exercising the way you were able to do before and did it go well?  If not there are ways that the rep can change the settings.  You might want to know what percentage of the time you are paced or how long your battery is expected to last.  Since you have two leads I would want to know if my ventricle lead is in the HIS Bundle, since that is the ideal location for people who get a lot of vetricle pacing.  

Some questions

by Gemita - 2020-06-12 19:17:35

Hello Sisterwash65,

What would be helpful is to ask for a copy of your interrogation data - at least the summary page setting out details like :-

percentage time you are paced in the upper chamber (right atrium) ?

percentage time you are paced in the lower chamber  (right ventricle) ?

whether any events have been recorded like an irregular heart rhythm, or a fast or a slow heart rhythm since your implant, or anything worrisome ?

whether your leads and battery are functioning normally ?  No doubt they are because you are feeling fine.

whether the settings are right for you or whether any adjustments need to be made (mention here your concern about symptoms like increasing blood pressure with higher pacing rate or anything else that worries you?

the exact position (site) where your leads are anchored.  For example mine (dual lead) are placed “right atrial endocardial” area and “left ventricle septal” area which I think is the norm.

your pacemaker mode ? - mine is set AAI<=>DDD

your base rate and upper tracking rate - mine is set 70 bpm and 130 bpm and rate adaptive is switched on.

This is all very technical and I won't pretend to understand it all but if you get a copy of your downloaded data you can discuss it here with everyone afterwards because your doctors cannot cover so much with you during your appointment.

I will leave others to explain LBB and 1st degree heart blocks since it is getting late here in the UK !!  Good luck


LBB and 1st degree heart blocks

by AgentX86 - 2020-06-12 21:15:55

This is pretty straight forward.  First, a "heart block" means an electrical  disconnect of the lower chambers (ventricles) from the upper chambers (atria).  A "complete heart block" (third degree) would mean that the disconnect is permanent and complete. First degree simply means that the conduction from the atria to the ventricles is slower than normal.  There is a high probablility that it will progress to second degree (too complicated tp get into here) and third degree (complete).

LBB = Left Branch Block.  The left branch runs up the outside of the left ventricle (the right branch, likewise runs up the right ventricle) and distributes the electrical current to the heart muscle on this side.  A block means that this doesn't happen correctly.

Pacing location: All pacing is done on the right side of the heart.  You can't get to the left side from the body's veins without puncturing through the heart wall.


First Doctor visit

by Sisterwash65 - 2020-06-12 21:57:31

Wow, these are some great things to know ! When I went to the doc for ““wound check” to remove the steristrips, he drew a diagram of the heart and showed me everything. It was information overload and I’m still trying to get it sorted in my mind. All of this information really helps and I so appreciate you kind souls that share your experience, knowledge and expertise with me. Maybe one day I’ll be able to do the same !

Please don’t hesitate to add other things I need to ask or find out on my June 30th visit.



Heart's electrical system

by AgentX86 - 2020-06-12 23:40:52

Sorry, I misspoke when I said the LBB and RBB ran outside the left ventrical.  It runs from the bundle of His (the section of nerve fibers from the AV node to the branch into the LBB and RBB), then the LBB and RBB continue down either side of the septum to the bottom and up the side.  With a block, the nerves don't excite the entire heart muscle so efficiency is lost.

Anyway, here is a decent diagram of the heart's electrical system.


Hearts electrical system

by Sisterwash65 - 2020-06-13 00:47:31

I was looking for an image earlier today so thanks for sending this link.

absolutely perfect diagram of the electrical system of the heart. I’m going to print this out and take it with me to my appointment !

Many thanks !

Finally . . .

by Gemita - 2020-06-13 05:35:57

Remember this is a learning process for all of us and our requirements for pacing may change over time.  Be patient and remember that our bodies need time to adjust to our lovely little devices.  Trying to change settings too quickly may not always be wise.  I found that by leaving well alone for the first year of pacing sorted many problems out without having any major pacemaker adjustments, although I did need adjustments to my medication - needing less of it - which was wonderful. 

More questions ?  Well think about any symptoms that you may have like do you get breathless if you try to exert yourself ?  Do you get any chest pain ?  Are you sleeping better or are you still feeling tired during the day ?  Do you get any dizzy spells ?  These are the sort of things your doctors will need to know about and will help them to know how well you and your  pacemaker are functioning and whether any fine tuning is necessary or a change in your medication might help.


Dr. Google?

by Graham M - 2020-06-13 19:02:28

Some people will say "don't trust Dr Google", but there is a lot of information out there on the web - from simple explanations to much more complex descriptions of heart diseases.  I have found it to be very valuable and learned a lot from various videos. My experience of cardiologists is that they will give you the smallest amounts of time and information they can get away with.

The best way to gather information about living with a PM is from this site.  There are some really experienced people in this forum and they are always willing to help.  3 of them have already answered your post and they are well worth taking notice of.

Best wishes.


First doctor visit after PM placement

by Sisterwash65 - 2020-06-26 17:56:43

On June 12 I asked this forum about what questions I should ask on my first visit after PM placement. I got some really good ideas about what to ask and have been doing lots of “ research!” I’m also taking notes on what I want to ask. Since then I’ve been able to access my Patient portal from my cardiologist’s summary on my case. I must admit it’s scary. I’m going to review it here as briefly as I can and ask any input or advice anyone can offer.

On May 28th I went to my cardiologist after my internist the day before called him and asked for me to be “ worked in.” I had been feeling lightheaded, weak and breathless for about 7-10 days. Back in September of 2019, I almost fainted, fell onto my knees, but didn’t black out. Same thing happened in late April. I was admitted to our hospital on 5/28/2020 for a Heart Cath. After the cath I was told “ I’ve found your problem.”He told me I needed a pacemaker due to AV third degree heart block and bradycardia, LBBB, and he said he could do it right away. My doctor then got involved in an emergency and it was almost midnight before I got my PM. I’m feeling MUCH better now and I’m thankful for modern medical technology ! Now to the Heart Cath summary. It says “ mild,, non obstructive, major pericardial coronary artery disease.” And then goes on to give specifics on arteries with stenosis, percentages, lesions, lightly and heavily calcified. And on and on...However, he determined there was no stent needed. This is my second Heart Cath with no stent placement.

info on pacemaker - Dual chamber PMRight atrium model, placement, RA appendage,RV Apex Medtronic PM.

Both of these issues sound equally bad and as I said I’m planning my questions to ask on 6/30.Im about 15 pounds overweight and am already trying to lose. During the lockdown I’ve been cooking and eating more than usual ! Also off salt and little caffeine.Using Half Caff one cup in the mornings. Trying to get my activity level up and can track that on my Medtronic app.

Soory about the long post but as I said, this is scaryand is keeping me up at night !

Thanks to anyone who can shed any light on what I need to ask or what I need to focus on from here on out. It is appreciated !







First device check after getting Pacemaker

by Sisterwash65 - 2020-07-01 08:28:29

After about and hour and a half wait, I finally had my first device check. The rep “ adjusted” my PM slightly and the “ wand “ read the info on my PM. Then she printed it out. She said All was working perfectly and my doctor was very pleased. PM was placed on 5/28 and I have felt SO much better I told them please not to change it much. I was told it was necessary to tweak it some to preserve battery life.My doctor answered every question I had. I asked him if I could see the XRay showing all my “equipment.” He said he’d pull it up on the computer in his office. So I saw it and it’s so incredible ! This all happened so quickly and totally unexpectedly that I think I had something like PTSD. At any rate, the visit yesterday helped me a lot. Also this site has helped tremendously. Some very knowledgeable people comment here and they’ve all helped. I have a Medtronic Azure XT DR MRI compatible pacemaker. It is dual chamber. The mode is DDD and I have a lead in my RA appendage and the other is in my RV Apex. My problem was Left bundle branch block, third degree heart block and bradycardia. The readout yesterday showed the RA was only pacing 6% of the time and the RV was pacing 93%. I’m so grateful for modern medicine and the technology !!  I have the Medtronic App on my phone. In 3 months it will send a read out of the PM’s activity which will be checked at my doctor’s office. Then I won’t have another device check until next summer.

although I’m not posing a question I thought someone else might be as anxious as I was about that first device check ! 

I’m a great believer in educating yourself as much as possible about your condition. Then you can be a better patient and a better advocate for yourself !





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