Hi Everyone

I am a brand new member of the Pacemaker Club. I had the intial implant done on 6th May and because the atria lead became detached I had it redone the followig day. All is now well but I have a question about something I do not understand.

At night when the beating of the heart is quite clear my heart rate increases to in excess of 100 bpm in what seems to be a controlled fashion and then settles down after several minutes to my normal resting rate of around 60. It is very noticeable and initially it worried me although it is less now than originally. I have had everything checked to make sure all is good. I am told that this behaviour is normal but no one has explained why, It does not appear to happen during the day.

If anyone can explain this it would be much appreciated.



Nocturnal palpitations

by Gemita - 2021-05-20 02:17:27

Ken, welcome.  What an excellent question and it does seem to happen to a lot of us.  I experienced tachycardia every night following implant as I laid down.  This continued for several months and I was very concerned and wondered whether I had made a mistake getting a pacemaker.  Personally though I have always been able to produce palpitations with positional changes, like lying down, bending over, so this was really nothing new and I put this down to compression like causes in the stomach area, especially with left sided sleeping.  

Of course the other thing to consider is getting a sleep study if it continues or if you wake up gasping for air, but that is another matter.

Causes?  As I drift into sleep apart from a slowing of my heart rate (now controlled by my pacemaker) I also experience, like most of us, a fall in blood pressure (which cannot be controlled by a pacemaker) and this alone can trigger palpitations for me at night.  If I stand up, sit up (change position) or move around and try to raise my blood pressure, I may be able to quickly stop any palpitations.  Being up during the day of course will help raise my blood pressure and heart rate and with a higher heart rate/blood pressure, palpitations (at least for me) are less likely to occur.  It is the falling heart rate/blood pressure on lying down to sleep that is my main trigger for palpitations   Maybe it is the same for you too? 

(My doctors explained that as I transition from the waking state to drowsiness and into sleep, my parasympathetic vagal tone increases, and sympathetic tone decreases.  As sleep progresses to the deeper stages, parasympathetic vagal tone increases even more. The net result is a reduction in heart rate, blood pressure, and cardiac output.  With falling pressures I am more likely to experience palpitations.  Does that make sense?)

It must be remembered that following implant this could also be so normal as the heart settles down to pacing.  Our hearts may have been traumatised by the procedure with the attachment of our leads to heart tissue.  It is entitled to throw a few palpitations and this will hopefully settle with time.  If it doesn’t and you are still concerned, your general doctor may look for other causes (apart from an arrhythmia), like infection, inflammation, gastric causes, anaemia, thyroid imbalances, blood glucose changes, electrolyte imbalances, dehydration, too much caffeine, stress and other health conditions.  Your doctor may also want to review any medication you are on since I found with my pacemaker I was able to get by on fewer meds, but it will be trial and error.

My advice, if your palpitations are over quickly, I would not be too concerned.  If they increase in frequency or duration, then I would seek further help.  You could also ask whether your clinic is carrying out nightly checks on your pacemaker at the same time each night triggering these palpitations.  This can happen.  

I wish you well and hope things settle quickly for you.

PM Self Test

by Persephone - 2021-05-20 08:11:38

Hi Ken - glad things are going well now after a bit of a rough start.  I have a similar experience each night when my PM does its self-check routine.  I found it worrisome at first before understanding what is was, and sometimes still a bit bothersome after 3 years.  If it turns out to be the self-check in your case, you could ask to have the timing changed to a later time when you are usually already asleep.


by PMken - 2021-05-22 03:18:52

Thanks for the comments. At this stage I am  not worried about it and ir seems to have settled down considerably. I have a consult with my EP next week and will ask him but as far as I am concerned it has stopped being an issue and is now just something I would like to understand. I have come to think it is as Persephone says and is the self check. It just feels a bit odd at times and I think it only natural to notice these things when they represent a change over what had been normal. I feel very well right now and I am sure it will only get better. Thanks again for your assistance.

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