Symptoms after pacemaker implant

I have had my pacemaker for 5;weeks now to treat my bradycardia.  I am still experiencing symptoms such as shortness of breath and palpitations.  These symptoms do not happen everyday but now and then.  I do not know what brings them on.  I am doing light exercises to try and keep fit. Just thinking how long will it take to feel normal again? Any information will be greatly,appreciated.



by AgentX86 - 2020-12-11 15:14:15

Welcome to the group.  Sorry that you had to be here.

Bradycardia is a symptom rather than a "disease". Bradycardia is typically caused by sick sinus syndrome (aka SSS) or heart block.  Are you chronotropically incompetent (heart rate doesn't respond to exercise)?  DId you have palpatations before?  Things matter because the pacemaker will be set up differently for each problem.  Without more information it's difficult to do more than guess.

Are the SOB and palpitations simultaneous. Did you have any arhythmias before?  Have you complained about this to your EP?  If you were given a remote monitoring box, I'd initiate a transmission when it's happening so your EP can catch the problem red-handed.


Symptoms after Pm

by Jam - 2020-12-11 16:39:08

I just started with light exercise and have not checked HR. I have had heart palpitations for years and was on,a,beta, locker which lowered HR to much,  So dr said p/M would solve the,low,heart rate but need beta blockers got,blood,pressure and palpitations. Prior to PM had monitoring and nucular stress test and heart catherization. All good showed no blocks,and,clean arteries I just  expected to feel great no more symptoms! Not the,case and am wondering what others have experienced after PM. Maybe I just need to be patient.


by AgentX86 - 2020-12-11 23:42:48

It's great that your arteries are clear but your problem now is electrical.  Plumbing problems can cause electrical problems but it's not the cause for the vast majority  of us.

A pacemaker can't get rid of your arrhythmia.  If you had it before, you'll have after.  Your doctor is right, of course.  The pacemaker will take care of the Bradycardia (it's all it can do) and allow for more beta blockers or other antiarrhythmics.  Most beta blockers aren't all that great at resolving arrhythmias either.

If I had to guess, I'd say that your EP (you are seeing an EP instead of a general cardiologist?) is waiting until your heart gets used to getting paced before adding antiarrhthmitcs.  You may have to wait some for him to get everything in balance.


by Gemita - 2020-12-12 03:22:29


WARNING long message follows

Your post could have been written by me a few years ago since I had similar thoughts and ongoing similar symptoms of palpitations/breathlessness even after what I thought was going to be a potential cure (my pacemaker). 

A couple of points I would like to make.

.  After 5 weeks you can still expect perhaps a worsening of rhythm disturbances before they get better because your heart has clearly been disturbed by the implant procedure, not only by the attaching of your pacemaker leads to your heart tissue but also by the fact that your heart will still be sensitive to being paced and being controlled when your heart rate falls below your pacemaker set minimum heart rate.  Mine is set at 70 bpm day and night and it was falling, prior pacemaker at night to low 30s bpm and even dipped into the 20s bpm on occasions, so pacing at 70 bpm is a big change for me and my heart!  At first (for approx 3 months) my palpitations increased and I experienced tachycardia and worsening breathlessness.

.  The second point I would like to make is this.  Although beta blockers/anti-arrhythmic meds can reduce heart rate as well as blood pressure and help dampen down palpitations like ectopics and more significant arrhythmias like Atrial Fibrillation and Atrial Flutter, they can in fact also make these very conditions worse because of the “slowing of the heart rate”.  To counteract this my EP has set my minimum heart rate higher at 70 bpm to help regulate my rhythm disturbances.  He called it “outpacing”.  It doesn’t (clearly!) work for everyone but for those of us who seem to get more ectopics and other rhythm disturbances “from a falling heart rate”, it is clearly worth a try.  

.  Finally, what brings on palpitations?  Many things can trigger palpitations as you can well imagine but I will run through the most likely:

. Dehydration can be a major cause of palpitations and throw electrolytes out

. Stress and anxiety (which includes any trauma to the body caused by an accident or surgery, or even a minor procedure like a pacemaker implant) 

. A falling of blood pressure (in my case due autonomic dysfunction) as well as a sudden slowing of heart rate.  This is without doubt my main trigger of heart rhythm disturbances.  Unfortunately a pacemaker cannot prevent a fall in blood pressure

. Lack of sleep.  A check for sleep apnea would be helpful

. Caffeine or alcohol (I can no longer drink either)

. A full stomach or certain foods (particularly acidic foods, spicy and high fat foods) or chilled foods, although chilled foods can actually stop my palpitations sometimes too!  A gastric/swallowing condition is my joint leading trigger of palpitations..

. Any illness may quickly trigger palpitations, particularly having an inflammatory illness like arthritis or lupus, a lung condition, a viral or bacterial infection somewhere, thyroid problems, diabetes, heart disease, valve problems 

. Anaemia can cause an irregular and fast heart beat and breathlessness

. Electrolyte disturbances (if these are out of balance you can quickly get some serious rhythm disturbances)

. Hormonal problems, e.g. loss of estrogen at menopause was a strong trigger for me

. Medication (many meds can affect heart rhythm and some may actually trigger palpitations or worsen them, so a medication review might be helpful).  

As you can see, so many conditions can affect heart rhythm and we cannot expect our little device to control all of these possibilities can we, and yet most of us do!  it is important to get checks in those areas that you feel might be causing your worsening symptoms if they do not resolve say after a few months (or sooner).  I hope and expect you have had all the usual blood/other checks to rule out the important potentially serious causes for palpitations/arrhythmia, like ischaemia although I note that you have had heart catheterization and found to have clear arteries.  Good news.  However microvascular disease is more difficult to detect and could still be present, so there is lots to think about.

Good luck Jam.  You will get better and find your solution I have no doubt.  You are still healing.  With perhaps some minor pacemaker fine tuning adjustments and a bit more time for your heart to settle, you will find yourself in a much better place.




Symptoms after PM

by Jam - 2020-12-12 09:20:01

Thank you for all the good information you posted! Really helpful to me.

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