Heart rate a lot lower than pacemaker setting

My pacemaker ( St Jude duel chamber) was installed 8/27/2020. I constantly check my HR with either Apple Watch, Fitbit (sleeping) and Omron machine.  My pacemaker is set at 70 bpm however the other devices (even at my doctor's office) show my HR at 39 to 44 much of the time while at rest.  The doc says i have an extra heartbeat that causes this. I had afib and went through the cardio ablation in November of 2019. Doc says not afid now but the extra heartbeat.  i am tired all the time and just want to nap.  Any thoughts?


Yes it is probably caused by ectopic beats

by Gemita - 2020-09-28 15:06:09

Yes I am afraid to say that ectopic (extra beats) can certainly trick our monitors into thinking that our heart rate is lower than it is.  This is because the extra beats are not always strong enough to be picked up by our home monitors, although our pacemakers can register the extra beat.  But it certainly feels like our rates are way down on those set by our pacemaker sometimes.  

My heart rate is set at 70 bpm and during ectopic beats (lots of pausing, flips and other nonsense is felt) and my home monitor registers rates in the low 40s bpm for lengthy periods sometimes.  I am presently querying this with my pacemaker clinic since I am not 100 per cent confident that my minimum heart rate is being maintained during episodes of arrhythmias.

You could try to ask your doctors if an increase in your minimum heart rate (from 70-75 bpm or even higher to 80 bpm) might help.  At least you could try this for a period, since I was told that a higher heart rate can often "outpace" an arrhythmia.  In the meantime, try to check your pulse manually (I check my neck pulse) but during ectopic beats, heart rate is difficult to assess.

Heart rate a lot lower than pacemaker setting

by KennyC - 2020-09-28 15:18:38

That was very helpful.  Thank you very much.  I have a follow up visit on Wednesday 9/30/2020 and I am trying to get my list of questions/ concerns for my cardiac electrophisiologist.


by Tracey_E - 2020-09-28 15:52:33

Gemita explained perfectly how our hearts can trick the monitors.

Afib can make you feel like you described, so can side effects of a lot of heart meds, particularly the first few weeks taking them. Be sure to mention it to your doctor. 

Heart rate a lot lower than pacemaker setting

by KennyC - 2020-09-28 17:15:36

Next question is, how to get rid of the ectopic beats.  I do not take many meds...only 25 mg of metoprolol and 81 mg of aspirin.  Can another cardio ablation possible solve the issue? I am a very active 73 year old male.  I do at least 30 minutes on elipical trainer daily and walk 5 miles every Saturday and Sunday. As mentioned, maybe setting the pacemake higher might be one thing to try. Any other ideas?


by Gemita - 2020-09-28 17:26:45

Can you go on a lower dose of Metoprolol or are you on it ?  Beta blockers definitely can trigger ectopics for some - they can for me.  Of course they can calm our arrhythmias like AFib too.  You could ask whether a calcium channel blocker like Diltiazem might be a better option for you but my recommendation is increase heart rate to 75 bpm first or check that your settings are optimised for you.

My EP would not do an ablation for ectopics unless they were really numerous.  You would need a holter monitor to check your ectopic frequency and duration to see if this warranted an ablation for a benign albeit symptomatic condition

Low heart rate

by AgentX86 - 2020-09-28 22:20:59

If it's not Afib, your doc shoud be able to tell you what they are.  If it's atrial, there should be a fix.  If it's ventricular, it's more difficult but still possible.  Gemita is right, though.  Unless it becomes dangerous they probably won't do anything.  Either way, you should know what you're up against.

BTW, ot often takes more than one ablation to stop Afib.  I know of one person who has had five failed ablations before getting probably the best ablationist in the country to finally take care of it.  I had three ablatoins for atypical flutter fail befoe my EP threw in the towel.  He identified the proble m in the left atrium but couldn't reach it.

Heart rate a lot lower than pacemaker setting

by KennyC - 2020-09-29 10:52:44

Thanks for all the input.  Another miserable night last night.  My heart missbeats, pounding, and fluttering kept me awake.  The thought that I have to continue to live like this without a solution is not very encourging.  I do enjoy a glass of wine in the evening but will be stopping that to see if it helps.  My EP had orginally told me 2 glasses were ok. I now have a whole new understanding of the meaning "qualtity of life".


by Tracey_E - 2020-09-29 11:38:57

Just because he said wine is ok doesn't mean it's not causing the problems. Caffeine can do it also, even small amounts early in the day.

Talk to your ep, it may be they need to change up your meds and/or your settings. 

Yes, please don't get downhearted

by Gemita - 2020-09-29 13:14:02

Before my pacemaker, ectopics bothered me so much, I would have gone into any procedure just to solve them.  A higher heart rate was all that I needed to provide good symptom relief and freedom from my PACs, PVCs.  For me, a falling heart rate was the trigger.  I am now set at 70 bpm (day and night).

You had your ablation in November 2019.  You should be well healed by now but some can develop other arrhythmias, including ectopics following an ablation.  Sometimes an ablation unmasks other electrical problems (arrhythmias) that may have been there all along.  I would definitely let your EP know just how symptomatic you are and push for answers, even longer term monitoring to see what is happening.  He might even consider an EP study to see where your ectopics are coming from if they are frequent enough or you are truly (which you are) symptomatic.  No doubt you have been checked for electrolyte disturbances, thyroid problems, diabetes, heart disease, infection, anaemia as potential causes and presumably you have had a recent echocardiogram ?

Unfortunately I cannot take alcohol nor caffeine without getting heart rhythm disturbances (neither cheese, nor chocolate).  All these will set off my arrhythmias, including ectopics.  You could try avoiding caffeine or alcohol to see whether your ectopics improve.  Many people are adversely affected by alcohol (wine)/caffeine, particularly AFib sufferers.  My palpitations are triggered without fail if I take either.

Did you have ectopics before your AFib ablation ?  They can make us feel absolutely miserable and when they become so frequent that they are almost happening every other beat, they can really cause problems with sleep and daily activities.  Some find a magnesium supplement can help (although ask your EP/general doctor first).  

During your EP appointment, I would want to see a "summary of my essential pacemaker settings" if you do not already know them, providing details like 

% right atrium pacing?

% right ventricle pacing?

Details of any events recorded like an arrhythmia, or high or low heart rates?

What mode you are pacing in ?

Base Rate, Upper tracking rate, Upper sensor rate (bpm)

AV delay (sensed) in (ms)

AV delay (paced) in (ms)

Whether Rate Response is on

There are so many settings, but armed with some basic information, you can learn what has been set up and question whether any of these settings could be optimised to suit you better?   A good question to ask is "what is my total daily ectopic burden (% for both PACs and PVCs). A high burden will definitely need treating or further investigation, particularly ectopics of ventricular origin (PVCs)

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I've seen many posts about people being concerned about exercise after having a device so thought I would let you know that yesterday I raced my first marathon since having my pacemaker fitted in fall 2004.