Recently advised pacemaker for Bradycardia

Hello -

I am a very healthy & active 68 year old male dentist. I was recently advised to get a pacemaker for Bradycardia. I had absolutely no symptoms but heart rate would constantly come up as low as 35 on physical exams. I was given a holter monitor for 24 hours and later told there is a complete AV block. Heart muscles are otherwise healthy as evidenced by an echocardiogram done today.  Very ambivalent about the pacemaker. What should I do?


11 Comments

Come on in, the water's lovely

by crustyg - 2020-09-14 18:10:15

Last person who asked this exact question received a *lot* of responses saying 'stop wasting time'.

Really, it's not a question of 'IF', it's a question of 'WHEN'.  The process that's causing your SA-node to slowly fail won't stop, and your resting HR will get lower and lower.  Then you feel faint, then you actually faint - and if you're driving or doing something where careful attention is required you'll be in big trouble.  And think how terrible you'll feel if someone else is hurt in the process.

Get your EP doc to set you up for a Bruce-protocol treadmill test: if you don't have CI then leave it for a while - perhaps a year.  If you can't get your HR up to something sensible for your age then the decision is made => get the PM.

Yes, there *are* some negatives, but they are far outweighed by the positives.

HTH.#

[Edited] Not my greatest contribution since you *did* say that you have CHB, not SA-node failure.  Sigh - late and I didn't read carefully enough.  But the message is the same and the other contributors put it very well.  Best wishes.

 

Go for it.

by Graham M - 2020-09-14 18:27:09

I have a Mobitz Type II block and was symptomatic, resulting in syncope that left me with scars on the back of my head.  It also left me with a pacemaker that has chenged my life for the better.  I have had mine for just over a year now, and am thankful for the people who invented such an amazing bit of kit.

You say you have no symptoms, but bradycardia is a symptom, and an extremely dangerous one.  With complete heart block, none of the electrical activity of your heart is getting through from the AV node to the ventricles.  It is only your escape rhythm that is keeping your heart beating.

Sooner or later, you will have more symptoms, and one of those possible symptoms is suddden cardiac death, so I would say that a pacemaker is a good idea.

The surgery is relatively simple and not too traumatic and the pacemaker will give you a new lease of life.  I was amazed at how much better I felt almost immediately.

Best Wishes,

Graham.

Third-degree heart block

by AgentX86 - 2020-09-14 18:34:14

If it were just Bradycardia I might wait a while, though 35 is getting dangerously low.  With 3rd degree heart block, I'd say there's no choice.  You're living off of ectopic heartbeats, which is living on the edge.  SCD would ruin your whole day.

If you're going to have an electrical problem bad enough to need a pacemaker, a heart block is the one to have.  It's the easiest to fix and as long as your SI node is still fully funcional the pacemaker doesn't even have to do all that much.  After a few months, you probably won't even remember that you have a pacemaker, any more than you have a little toe.

Thank you

by englishtea - 2020-09-14 19:23:50

Thank you so much for the kind answers. This will comfort my family.  I will be notified within a week and will go for the procedure since it seems inevitable. Is there any other research I should do? Type of PM etc? Have all of you been able to go back to your normal life? I would like to continue to practice dentistry for a couple more years.🙏

Research

by AgentX86 - 2020-09-14 19:50:46

You can look up "heart block", "two lead pacemaker", "AV node", pr "heart conduction system".  These will give you enough alleys go go down to give you information that you should have before this procedure.

There is a greater than 99% chance you'll be as good as new in short order.  Much of the 1% is a completely correctible complication.  The surgery itself is about as simple as any surgery can be.  I had only local anesthetic.  The only pain was when they made the pocket for the pacemaker - bad but tollerable.  With even consious sedation, even, there would be no pain.  There really is no reason for general anesthesia but it's something worth asking about.  A gneraly will give you a hangover, likely worse than the surgery.

I'm 2-1/2 years out from my PM implant but I'm better than new.  I had some unrelated issues a year ago but since that settled down, I feel better than I have in years, if not decades. 

I'm probably going to retire in the next six months or so but only because work isn't much fun anymore - and it's time. Fifty years does that. Though Covid has been a positive, one one respect. Working from home and when I do go in, there's no one to bother me. So, six months from now oughtta be good.  Three years ago, I was almost ready to throw in the towel.  I couldn't sleep so could barely function.   I'm an engineer and brain fog isn't at all helpful when designing stuff.

Go for it.
 

I have complete heart block too

by Ms M - 2020-09-14 20:16:40

I am a relative newbie here. I am 61 and had my dual lead pacemaker for complete heart block on October 19, 2019. I wasn't given a choice as it was discovered in the Emergency Department at the hospital. My symptoms started out with occasional breathlessness and then dizziness. The night I was admitted, my heart rate dropped to 25 and my heart stopped for 6 seconds. I have no "plumbing" issues either-I had a Cardiac MRI before the surgery. As the other very wise, very knowledgeable members have suggested, don't wait. I have since learned that I have no escape rhythm meaning I am 100% dependent on my pacemaker.  Some people may still have an escape rhythm with heart block.  I am so thankful for this technology that saved my life. I could've fainted, the consequences of which I would not want to think of. After the implant when I understood the condition that warranted the surgery and the seriousness of it, I did go through some anxiety but I got help for that and coming here to ask questions sure helped. I will tell you that I am living a normal life and yes, some days I don't even think about it. I was a little obsessed about checking my pulse in the beginning but that stopped a long time ago. It's doing its job!  You will have some restrictions for a few weeks but thankfully my recovery was pretty easy. I am retired and have returned to golfing three times a week, walking and gardening.  From this support group I learned which questions to ask of the Techs who do the checkups.  I asked about where the leads were placed (saw my X-ray), my pacing mode, how the lower and upper limits of the pacemaker work, how long leads last, what happens if the leads need to be changed or what it means to be 100% ventricular paced and what that might mean in the future.  I've been told by the Techs that I know more than the average recipient because of the questions I'm asking and it's thanks to this and other pacemaker support groups.  I didn't get a choice of which pacemaker I got but it is MRI compatible which I think is important. I don't often comment here but your story caught my attention. I hope my experience can help you a little bit. Keep us posted!

Just Do It !!!

by Sisterwash65 - 2020-09-14 21:48:19


My 2 cents worth:

Just got my PM in May due to Complete Heart Block. I had 2 near fainting spells, months apart but went downhill fast with shortness of breath and tiredness along with Bradycardia. I just want to confirm everything already stated here. Get your pacemaker.  You'll be glad you did.

It's no worse than going to the dentist ........

by IAN MC - 2020-09-15 07:09:46

Enjoy !

Ian

after

by Tracey_E - 2020-09-16 08:54:24

If you have av block, that's a pretty easy fix with a pacer so any of them will do. People with sinus dysfunction who are active need to do a little more research, for the rest of us any of them will do. There aren't really that many out there- St Judes/Abbott, Medtronic, Boston Scientific and Soren. The main differences between them are in rate response, which we don't generally need with av block. 

There is no reason why you can't practice dentistry once paced. There is nothing I want to do that I cannot. Having the pacer gives me more energy and keeps me safe, it's not at all limiting. I've been paced 26 years for av block. 

I was in third degree heart block with asystole...

by Mark.n.NC - 2020-09-26 03:52:08

Doctor,

I went to the hospital after passing out at home three times in one morning. Got to the hospital and while I was in the ER, I passed out twice. Turns out I was in asystole and complete heart block. My heart would stop, then 12 to 15 seconds later it would start back on its own. When I came to in the ER the second time, the room was full of hospital personnel including a cardiologist giving orders. They rushed me my ambulance to the hospital campus 20 miles away that cares for critical patients including heart patients. Two hours later I was implanted with a Medtronic two lead pacer. I went home the next day. 

Honestly, it saved my life and it has made me feel much, much better. If I had just stayed home and ignored it (I ignored three previous episodes, however I did not pass out during those) -- I would most likely be dead now.

My advice, if you're in third degree or complete heart block, what are you waiting for? Do it. You'll be amazed at the peace of mind it gives you (not to mention saving your life). My heart will not go below 60 BPM or my pacer kicks in. Thing is, after I had the pacer inplanted, I've had no major episodes and my heart works on its own 99% of the time. But should something happen, the pacer is there. I'm checked every three months, usually using my remote device which interrogates my pacer just to make sure everything is okay. So far, so good.  

Remember the old saying: It is better to have it and not need it than need it and not have it.  My advice: Make the appointment and do yourself the favor. You won't regret it.

3 week mark on the PM

by englishtea - 2020-10-18 00:09:55

Hi-

It has been 3 weeks since the Boston Scientific PM was installed. I am having difficulty on gradients which I didn't have before. Is this normal? I a frustrated that something I could do so easily is a bit of a struggle now. Any advice?

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Good luck with your surgery. It will improve life amazingly.