Pacemaker setting

I was just at the ER over the weekend thinking my settings needed to be checked as my heart rate was fluctuating.   It ended up being my anxiety.   I am so frustrated.   They said that my Hearts own natural pacemaker has been taking over and that the interrogation report shows my pacemaker working as it should.   I have seen my heart rate drop to 45 on the pulse oximeter and thought the pacemaker had kicked in.  But they said no.... it hadn't.  Im so confused and frustrated.   (I do have an appointment with the pacemaker clinic next Tuesday.)

Any insight, advice ,etc would be greatly appreciated 

2 Comments

And, unfortunately, anxiety makes it worse

by crustyg - 2020-11-16 18:18:07

I have SSS+CI, and have a resting HR of 28-30BPM without a PM, so I'm 100% paced (LRL of 50).  But my AV-node can still generate *some* activations if I get upset or the fight-or-flight sympathetic drive kicks in.  I notice this if I wake from a bad dream - rapid HR, irregular, as my AV-node paces me, and the PM paces without recognising the ventricular activations occurring naturally (only RA lead is active, little retrograde conduction).  Over about 20-30s it all calms down, AV-node slows down and PM takes over with a regular HR of 50BPM.  I go back to sleep.

Something similar may be happening with you, and the more that you worry about it, the worse it becomes.  Ectopics (another cause of runs of irregular beats) are made much worse by anxiety, and any natural pacing tissue that you have will probably increase its activity with anxiety or sympathetic drive.

Focus on whether you can now do what you need to in your life.  Folk without a PM often have ectopic beats, bursts of rapid HR, but because they aren't heart-aware as we are, they don't usually notice so they don't worry.  Not *always* a good thing, but in general, excessive worry only makes us ill.

[Edited: some late-night AV/SA node mental confusion.  Sigh!]

Pacemaker kicked in?

by AgentX86 - 2020-11-16 20:34:55

You didn't say where your minimum is set but whan you say your pulse-ox reports "rate drop to", I get the picture that your PM minimum is set above this, yet your PM didn't "kick in".  Pulse-ox meters don't handle ectopics well.  Your excitement probably made them worse, which makes the pulse-ox all that much less reliable.

If this happens again, measure your pulse manually.  You may feel "skipped" beats.  They really aren't skipped but are (almost) too small to feel.  There may be a big one and a little one right next to each other, then a pause and it starts over.  This is what your pulse-ox is trying to follow and it can't, so it lies.  If this is what's happening, you're probably getting PVCs.  They can feel like crap and can be scary but they're almost always benign. Tell your doctors about them but don't panic.  It'll only make them worse.

When in doubt, always count manually.

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