Pacemaker

Hi. So, I have vasovagal syncope. Needles are very upsetting to me. My pulse goes down to 30 and then I have experienced a heart pause. The one they recorded on my tilt test was 3.2 seconds long. I am struggling with the recommendation for a pacemaker because I don't experience syncope episodes outside of triggers. I have not had the best time getting my questions answered by the doctor. I think I would feel better if I could understand WHY the recommendation was being made. 

I am feeling overwhelmed and uncertain about scheduling the procedure when I don't feel like I understand the reasoning behind the recommendation. I passed my stress test no problems and my halter EKG was also normal. Outside of the brachycardia and the pause in my heartbeat during the tilt test (and a severe syncope episode during an endoscope also brought on by needles), I don't experience any other symptoms I am aware of and again none were picked up by an EKG. 

I have a follow up appointment with my NP on Thursday 05/19/22 but so far everyone is feeling very forceful about implanting a pacemaker rather than assisting me in understanding the reasoning behind it. The research I am looking at show that pacemakers are the last resort treatment for syncope and used only in rare occassions. They also prescribed a beta blocker but couldn't answer questions about this either. (Like if I would need to take it for the rest of my life.) And the research I have done on this indicates it could be contra-indicated for syncope because it can reduce both heart rate and blood pressure. Also, between a placebo and a beta blocker there was no substantial difference in the effect on syncope. 

Has anyone else had a pm implanted based on a diagnosis of syncope? 

4 Comments

vasovagal

by athena123 - 2022-05-14 15:01:51

Ok, so is anxiety triggering your syncope because you mentioned that needles brought about a reaction. By no mean am i a doctor but you seem to have a pause of about 3 seconds., which is your heart is pausing which is never a good sign. Drinking plenty of fluids along with electrolytes and magnesium can certainly hepl> have you ever had a sleep study done to monitor your breathing patterns, i would have an EP doctor looking at your situation and see what options might be available to you. best of luck

vasovagal syncope?

by AgentX86 - 2022-05-14 15:16:43

How can it be vasovagal syncope if you've never had a syncope event? Oh well. A three second pause isn't really a big deal, particularly if it was forced. OTOH, think of a 30bpm heart rate of 30bpm a a long string of 2 second pauses. Not good either. If they haven't done a Holter, or equivalent, I'd be cautious too. It seems that you're not getting the answers you deserve. I'd suspect that you aren't getting the care that you deserve either.

W lot of us have had dsyncope events. I never had syncope but came very close. I had an eight second pause, which was a hair on fire event for my EP. I'd had three second pauses for a long time and it was a ho hum thing. My EP's threshold of worry was five seconds, or of course, syncope. Syncope can be deadly to you or if you're drivifng, even a six year old girl riding her bicycle. It's that serious. Yes,it's a reason to get pacemaker.

Don't get me wrong, syncope can be deadly (driving,  stairs,  etc.) But you need better information. At least get a second opinion from someone outside your doctor's group. If you need a pacemaker, just do it.

Why a pacemaker?

by Gotrhythm - 2022-05-19 17:09:23

The reason why is very simple.

Vasovagal syncope means in non-medical terminology that you have a glitch in your autonomic nervous system. Instead of telling your heart to speed up when you have a drop in blood pressure (to keep oxygen going to your brain) your autonomic nervous system tells your heart to slow down. That's what's going on when your needle reaction makes your heart rate fall to the 30s.

Strange to say, there could be nothing wrong with your heart, but it's getting the bad signals sometimes.  These bad signals could actually stop your heart as you saw in the tilt test with the 3.3 second pause.  Not long enough to be dangerous in itself, but it tells you that a longer pause could happen.

What a pacemaker does for someone like you is purely to keep your heart rate from falling past a certain point. That's all. It doesn't fix the VVS. You can still faint. Wouldn't be worth doing, exect that one time your heart rate could fall to zero and it might not recover on it's own, and neither would you. 

I have VVS also. It was discovered after I already had a pacemaker so I never had to make the pacemaker decision. However, I would get one in a heartbeat (ha-ha.) Your pacemaker will essentially be doing nothing except keeping track of your heartrate and intervening only when your heartrate drops. You probably won't even feel it happen, or know about it until your semi-annual pacemaker checks.

Do not assume you know what your triggers are! Yes, you know the ones you've already encountered but you don't know what else or what conditions could also cause your heartrate to plummet. You might get along okay for years but could happen anywhere at any time--and at the worst possible time.

That's why in a nutshell. Hope this helps.

BTW the stress tests etc showed no problems with your heart. The Tilt-Table test is definitive for VVS. You didn't pass it except for the 3.2 second pause. The pause itself tells us your autonomic nervous system sometimes sends the wrong message.

Get a second opinion.

by PacedNRunning - 2022-05-22 02:33:20

I personally would get a second opinion. especially since it's brought on by needles etc. 

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