Adjusting Isn't What I Thought It Would Be

Background: Hip replacement Jan 5, 2021. Double lead Pacemaker April 15. 2021. 76 year old Male, Hamilton, MA. 2nd degree arterioventricular block.

I had been trying to get back to normal after my January hip replacement and was working out and doing yoga.  No symptoms from that at all. When the weather broke here, I thought I do some cycling. Bear in mind I had zero symptoms that I noticed up to this point. maybe a little winded doing yard work which I attributed to being inactive before and after the hip procedure.  My short bike ride (1.8 miles) involved a couple of hills which I should have done without any trouble at all.  I was totally wasted. When I got home, my wife (a nurse) took my pulse, made a face, called our PCP and was told to go to the ER. Symptoms: erratic heart rate. from 34 to 88 and back again. Curiously when I calmed down a bit the next, my heart went into sinus rhythm. I was hooked up and awaiting a stress test when the cardiologist came in and looked at the monitor.  He said "Sinus, no problem. Let's do the test." When I stood up, my heart went immediately into second degree block.  The cardio cancelled the test.

Now I am one week post op. Heart rate has been checked and back to sinus. When seated I am fine. When I walk around the park across the street I get light-headed. It is an odd feeling and not what I expected. My question:  Is this a simple matter of adjusting to the PM? I am out of shape? Is there something else that might be going on?  I appreciate your thoughts in advance.




by AgentX86 - 2021-04-23 18:19:01

It sounds like you have Afib, as well as your second degree block.  Pacemakers are perfect for fixing heart blocks.  In this application, all they do is bypass the broken wire between the atria and ventricles. Simple. 

OTOH, they can't do a thing for Afib.  A PM can keep your heart rate up so stronger/higher doses of drugs can be used to settle the Afib but they don't treat AF at all (well, under rare circumstances...).  All they can do is sit and watch AF.

Pacemakers can only make the heart go faster.  They're accelerators, not breaks. 

In your case, it's probably not a matter of settings unless they just took it out of the box and plugged it in without setting it for your condition.  Since your only problem is heart block (other than AF), you shouldn't have "rate response" turned on, which has dozens of settings to get right for each individual.  Yours should be fairly straight forward.

Are you slipping, periodically, back into Afib?  "Paroximal" Afib is very common (something like one in every sixty people).  Some are highly symptomatic to AF, others aren't bothered at all. The circumstances where people go in (or out) of AF vary all over the place from exertion to couch sitting, from to eating spicy food to eating too much. AF can present itself exactly as you describe.

I'd recommend a Kardia Mobile device.  They're under $100 and connect to a smart phone (either by Bluetooth or sound, depending on the model).  They will give an ECG and a Go/No-go/Maybe on Afib and can be used to email your ECG to your cardiologist for further action.  AF can be a hard to isolate.  This device will allow you to capture your hearts condition when you're feeling the problem.  It's a great aid.  The only down side is that some become obsessed with them, constantly taking their ECG, whether needed or not.


Walking, biking and rate response

by Loretta - 2021-04-23 22:36:14

I am also new to the pm club. I have sick sinus syndrome.

Before Pm I was walking two miles a day,rode my bike ,no issues. After pm I couldnt walk to the mailbox with out shrotness of breath,palpatations,then having to hit the couch the rest of the day totally wiped out. As the days went on, I forced myself to walk further with the same results. .25 was my limit. Very frustrating. It was like the pacer was trying to stop my hr from catching up with my actual activity. I had no idea why I was so wiped out as well,but it was terrible.

I told the pacer nurse what was going on at my one month appt. She adjusted it and she turned off the rate response. What a difference it made and every day it got better and better.

Im three months into my new pacer and can now walk two miles and rode for five the other day.

Aside from your body getting used to the new Pm ,ask about adjusting it and the rate respose feature. Other than that ,from what I have read ,we have a long adjust periord ahead of us. 

Hang in there.




by sfp1 - 2021-04-24 22:54:29

Hi Michael,

I also have a double lead PM. I was so sick before I got my PM and I felt so much better after I got it, that I didn't notice at first that things still weren't quite right. I felt 75% better, but wanted to more.

Initially, my PM was set to pace on one atrium and not the other because they thought the other side was pretty healthy...but I couldn't get over this feeling that I should be feeling better and should be able to do more. After many trials with my PM nurse, we adjusted my PM so that it has variable response for when I am exercising . I also now pace 95% of the time on one side and about 45% on the other. Having the the left side keep up better with the right side has helped me feel better. 

Light headedness is not a good sign (or way to feel). I'm not medically trained, but it sounds like you need to have your settings checked more thoroughly so that you are pacing the best way for your unique situation.

Sending you good thoughts!


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