broken lead

I am an extremly active 72 year old.  I do a variety of exercise, with swimming being a prominent one. I have had a PM for about 2 1/2 years to address SSS, bradycardia etc.  Before the initial surgery I was told the the device would sense my motion and respiration.  Then they gave me a Medtronic with just the motion chip.  I was told later by one of the device techs that it was because of the hospital's "business plan".  This device does not work well in the pool.  After numerous adjustments, it became sort of acceptable.  Because I had other concerns with the initial cardiology outfit I ended up switching my care to a doctor in Portland, Maine who has a reputation of being tuned in to active older people.  I have been very pleased with him.

This year, I have been quite pleased with my physical conditioning, including swimming.  Then a problem developed a few days ago. I had a lot of work to do with fallen trees at a seasonal location. I spent 6-7 hours working with a friend to move and split a bunch of red oak, heavy stuff.  I used a hydraulic splitter but moving the wood to it was the hard work.  At some point during the day, I started complaining that "this sholdn't be this hard".  Something just did not feel right.  The type of work was very different-I figured I just wasn't used to it.

The next day happened to be the day for my remote monitoring.  I got an email to that effect early in the day.  I little while later, I got a phone call from the doctor.  He asked me how I was doing and I told him about the way I felt the day before.  He responded "I think I can explain that, you have a broken lead." He said it was not my "primary" lead but that it would need to be replaced.  He said they were scheduling about a month out and in the meantime, I should go about my usual activities  as long as I coud tolerate them.  I had a swim time scheduled later that morning and I went to that and it was just awful.  I have not felt that bad in a long time.  Right after that, I happened to have a dentist appointment where they took my BP.  It was 95/64.  Subsequent checks with my home monitor have been comparable.  Pre-synchope has been a constant companion.  I felt like the PM wasn't working at all although my HR didn't seem to be going below 60.

I called the cardiologist's office to reported my symptoms.  I ended up getting an appointment on 5/21.  The dr. indicated that it will be appropriate at this time to give me a device that will hopefully serve me better with my lifestyle, especially the swimming.

 

Sorry for the long narrative but I have a couple of questions that I hope someone on the forum can answer.  Does anyone have experience with a device that works well for swimming?  I know the Boston Scientific has the micro-ventilation sensor and that may be the direction we're going. I remember readingn something on this forum quite a while ago about (I think) a German model that uses a different type of rate response that might work well.  I would just like to know all options.

I am also interested to know if anyone has had experience with low BP after any aspect of device failure.  I think that is really affecting the way I feel and I'm not sure I see the connection with a broken lead that is not even the primary lead.  As I indicated, my exercise intolerance right now is worse that before I got the PM.  Five days ago I was just fine.

Thanks for any thoughts.

 

3 Comments

Swimming is difficult for RR

by crustyg - 2021-05-01 10:26:24

I have Accolade, with Minute Ventilation (MV) enabled and tuned for me.  I can attest that it's not great at getting my HR up during swimming.  If you think about it, most indoor swim styles emphasise breath management and keeping the shoulders flat, rotating the neck to breath.

I'm told that Open Water swimming deliberately demands more shoulder rotation (to see the markers), so actually the accelerometer is probably a more reliable feed into Rate Response (RR) than MV.

I can see how either MV or Accel could produce a good RR for me - except that to do that I would need both of them set close to maximum sensitivity - which I really don't want.  I've just done 2h on the road bike this AM (53k) and was >150BP for 91% of the entire ride, so increasing sensitivity wouldn't make sense for me.  Ideally, I would have a second PM profile for swimming, but I've banged that drum enough.  It won't happen in my lifetime.

Broken lead

by Gemita - 2021-05-01 10:47:45

I am sorry this has happened to you just when you were getting back to a level of activity you could live with.  From your post it is reassuring you have found such a good doctor in Portland who has experience working with active older people.  Your symptoms are suggesting that you need that 2nd lead back pretty quickly even though some of your symptoms may not be totally related to your fractured lead.

I attach a couple of links which might be worth a read while you are waiting to hear from the swimming community.  

https://www.pacemakerclub.com/message/31078/swimming-specific-device-choice

or see tips towards end of next link under heading "A better way to Pace?" and "Resurrection"

https://www.usms.org/fitness-and-training/articles-and-videos/articles/pacemakers-help-keep-the-beat-going-for-masters-swimmers

I wouldn’t necessarily assume either that your blood pressure problem is because of a lead failure and it sounds to me with all of your symptoms - pre-syncope, sudden blood pressure falls and feeling worse now than before you got your pacemaker, something else might be going on too.  I note that you have SSS.  I wonder whether both leads are affected, or whether you have caused any other issues with the heavy tree work?  Personally in your shoes I would err on the side of caution and get examined as soon as possible, I wouldn’t wait until 21st May.  What did your cardiologist say;  did you tell him everything, how you are feeling, the presyncope, blood pressure problems, poor exercise tolerance?  I would either go to see your general doctor for some checks or to the hospital if you continue to feel poorly.

I hope for the very best for you.  From now on perhaps it would be "safer" to focus on staying active and well within your own limits, leaving any heavy tree work in the future to the tree surgeons.

RR

by Sibber - 2021-05-02 08:33:25

To answer the easy part first: there are a few different methods to achieve rate response. The most common are accelerometer and minute ventilation. It's sounds like the accelerometer has been working OK for you but MV would probably be better. MV can also be 'blended' with accelerometer in most Boston devices to overcome some of the problems associated with breath holding in swimming. The third option you referred to is closed loop stimulation in Biotronik devices. In a nutshell this uses the contractility of the heart for its rate response settings. In my experience swimmers, at least casual ones, don't seem to prefer either method.

The lead issue is harder to answer without more information. It sounds like the atrial lead is 'broken'. However how that manifests could be a number of different issues from loss of capture, noise tracking, inappropriate mode switches etc etc. Either way the issues you are having are likely to be due to this lead (probably with some psycho-somatic issues too - we all look for problems when we are told there is one) and should resolve when it is replaced.

Hope that helps

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