Micra - teething issues?

Hello. I'm very new to this forum, as I just had a Micra (trans-cathether, leadless) PM fitted last Friday, after a series of cardiac arrests earlier in the week. For context, I'm a 45 year old male with no previous history of heart issues. So I'm only 3 days in to having a PM.
As it stands, I feel pretty well but am very aware that the Micra is pacing on the hour, every hour, like clockwork, regardless of my activity. I'm told it's set to pace at 80 bpm but only if my pulse falls below 40. Having been monitored all week to the ECG in hospital, I know my resting awake heart rate is about 66.
My question: Is it usual in the initial stages for Micras to pace intermittently like this? I'm wondering if perhaps it's calibrating itself based on how my heart responds. Needless to say, it's been quite disconcerting as no-one told me it was just going to started pace like this regardless of my activity level or heart rate. 
Grateful for any informed advice from fellow Micra patients. Thank you! 

p.s. I have been trying to speak to a clinician over the weekend but the pacemaker clinic was closed and the advice I did get was pretty vague and second hand through a nurse. Will be trying to speak to a doctor again today, but I thought it would be useful to hear about any first hand experience from patients as well. :)


Confusing message

by Gemita - 2021-08-02 12:04:07

Hello Rob,

Welcome to the forum

Hopefully by now you will have spoken to your doctors and addressed some of your concerns, since they will know your settings.   There are a few Micra leadless pacemaker members here but the majority of us have conventional lead systems either single, dual or triple lead pacemakers. 

I am glad that you are feeling “pretty well” following a series of cardiac arrests and your implant last week.  That is a remarkable recovery and it does surprise me, although I see you are fairly young with no previous history of heart issues.

Your message has certainly confused me Rob and I do not think, with respect, you have fully understood what has been set up.  You say your Micra is pacing on the hour, every hour, regardless of activity.  I would hope your pacemaker paces you as often as it is needed, not just “on the hour, every hour”.  You then go on to say that it is set to pace at 80 bpm but only if your pulse falls below 40 bpm.  This statement doesn’t make sense, at least to me.  Are you saying your lower rate (base rate) is set at 40 bpm?  A lower (base rate) setting of 80 bpm would seem more plausible and then if your heart rate fell below this level, you would then be paced to maintain 80 bpm.   A base rate of 40 bpm would be too low for many of us and you need clarity here (although I note your natural resting heart rate during the day is around 66 bpm).

To give you an idea, my lower minimum pacemaker rate, known as Base Rate, is set at 70 bpm.  Many have it set at 60 bpm, or even 50 bpm, but 40 bpm?  Seems rather low.  If my heart rate tries to fall below 70 bpm, my dual lead pacemaker will kick in to maintain 70 bpm.  I would ask your doctors the following:-

What is my lower heart rate (base rate) set at?

What is my upper heart rate (upper tracking rate) set at?

What is my diagnosis (for example do you have ?Sick Sinus Syndrome, Heart Block, scarring from cardiac arrests, or something else?  You don't tell us why you have your pacemaker Rob?

More questions

by Gotrhythm - 2021-08-02 12:45:05

Three cardiac arrests must have been scary! I'm sure having a pacemaker is helping your peace of mind, knowing that the pacemaker will not allow your heartrate to fall below 40. But I echo Gemita's confusion about what is going on with your pacemaker.

How do you know it is pacing every hour on the hour?  What is happening or what do you feel? Are you sure it's the pacemaker? What does the reference to "teething issues" in the subject line mean?



by ROBO Pop - 2021-08-02 13:15:27

Quite obvious you are confused. I suggest you study up on your condition and how pacemakers are used to treat it. As the ladies said your comments ...

Teething Issues

by Marybird - 2021-08-02 15:28:48

I think Rob's comments about "teething issues" probably have to do with his learning process about his recent experiences of having a Micra pacemaker implanted, and just what all this means to him going forward. He's using the expression "teething issues" to indicate he's brand new at all this, starting from scratch, and in the process of learning about all things pacemaker, cardiac conditions that result in pacemaker implants, and how these apply to him.

Rob, Gemita did a good job of basic explanations, considering there's not enough information about your condition to make those explanations more specific. The questions you have are really for your doctors, or other health providers, they need to explain to you just what has happened, how it's affected your heart, and why they implanted a pacemaker, and why they chose the type they did.

recalibration possible....

by BOBTHOM - 2021-08-02 17:54:01

The on the hour "pacing" may well be a recalibration.  My ICD was poking me every night/morning at about 1:30am.  I spoke with the doctors/clinic, all denied that there was anything wrong and it was definately NOT the ICD  Then I called medtronic who told me that the device does a recalibration every night and that it was a "feature" and that the doctor can turn it off.  Armed with this new info I called the doctor/clinic, and they again denied it was the device until I told them that I spoke with Medtronic.  Then they said they would have to check further, 2 days later they reluctantly had me come in so they could turn it off.  My thinking (as the mind reader I know I am) was that they were hoping I would get used to the sensation because the device would function best if it did this recalibration nightly.  Now they have to do it manually at the annual check up. But what do I know, I'm not a doctor.

Good luck with getting the settings and your expectations properly met..

Teething? And learning to communicate

by Gotrhythm - 2021-08-03 13:49:28

Marybird, thanks for the clarification. Makes perfect sense. Clearly, after more than a year in the "bubble" I need to get back up to speed on colloquial trends. LOL!

BOBTHOM, I don't have a Micra, so I don't know much about them. I have to wonder if a device would reallly be programmed to run a check or recalibration hourly.

Rob, even after 10 years I well remember how confused and helpless I felt as I tried to come to grips with having a pacemaker. All I knew about heart issues is what everyone knows, i.e. heart disease, and that doesn't even apply, if you don't have a heart disease--and many of us don't. We have heart arrythmia conditions. As for pacemakers, I knew absolutely nothing. I couldn't even guess at what questions I should be asking.

Here are some general things you might need to know. 

1. It's uncommon for people to feel the pacer pacing. Some do of course, but it's unususal.

2. What you feel is ALWAYS VALID. If you say you feel something, well, you do, and no one can say you don't. But, we don't always have the knowlege to correctly interpret the cause of a feeling. When you say you feel "pacing" every hour on the hour, I'm sure you feel it. I'm just not sure what you feel is "pacing." And I'm not knowledgable enough to guess what else it could be. I would ask, is the "pacing" feeling disturbing your sleep? If so, that's not good. You need sleep. Don't try to tough it out. Tell your cardiologist.

3. The pacemaker settings you describe are unusual for the commonly seen conditions, like goood ole Sick Sinus Syndrome. That doesn't mean they are wrong, or that you have misunderstood. Different conditions may call for different settings. But the thing you need to know is that the "right settings" are the settings that are right for you!

How do you know if they are "right?" Simple. You feel good. You can do what you want to do, including strenuous activities, and rest well at night. Sometimes it takes several adjustments to fine tune your pacemaker. Be patient, but don't accept merely good enough. Insist on getting the best adjustment possible. It's about having a life you can thoroughly and vigorously enjoy.

4. It's impossible to know too much about your heart condition. The more you know the better partnership you will have with health professionals, and the better you will be at educating those around you about what they need to know in order to support you. The more specific you can be about your condition when you post here, the more likely it will be that you'll get answers from someone who has that condition too, and knows exactly what you're talking about.

Finally, I'm sorry I didn't understand the teething reference. You did nothing wrong. The failure to communicate was all mine.

Keep coming back. Keep asking questions. I'll try to do better.


Teething issues

by Mek - 2021-09-15 19:15:36

Hi, I got the AV in June 2020.

I had to get some changes made to the settings twice before sometime last October / November I started having the on the hour double hits.  I had them until March when I was finally able to find someone who belived me and got back into the clinic.  It drove me mad but it became a highly amusing party trick as I could tell anyone the time as long as it was XX:54... as it happens I think the recal attempt is set to 59mins 59seconds as over those few months I lost about 4-6 minutes!

It also only paces when I drop below 40bpm so you are not alone!

All jokes aside the hourly recal is an easy fix (if they turn off the right function which related to threshold capturing and if this is ok with you / them).  I still do not know why it started when it did, ultimately it is set up to "intelligently" tweak the pulse variables to optimise battery life based on your bodies requirements at the time.   Now mine is turned off we use fixed variables which will be checked annually instead.

p.s. I also feel it when it is pacing when I am awake but have got used to it now at night and it no longer disturbs my sleep.

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