Heartbeat in armpit

I just had a new PM put in after 10 years as my battery life ran out. I have a Medtroic Azure XT and I bascally pace 90+ % of the time in the atrium but at my first check up I was pacing 25% of the time in my ventricle so they made a slight change to my settings. I am pacing a little fast but I feel my heartbeat in my armpit , not always , but enough to be annoying and with no rhyme or reason. Originally I thought it was happeneing mostly when I woke up but now it seems to be more random any time of the day. My ventricular lead is compromised but since I don't use it, I didn't get it replaced but it was hooked up. Could this have anything to do with it?


Do you have a new lead?

by Gemita - 2023-12-31 12:02:57

Your post is slightly confusing since you say “My ventricular lead is compromised but since I don't use it, I didn't get it replaced but it was hooked up”.  

If my understanding is correct, I see your ventricular lead became defective some years ago and it seems it has now been connected again and left in place instead of extracted?  

You then say that when you returned for your first check up after your battery change, your ventricular lead was pacing 25% of the time and they made some settings changes.  Does this mean the ventricular lead is still functioning to a degree?  Perhaps you could kindly explain what exactly was done, whether they placed a new lead after (?capping) the defective one and leaving it in place, or whether the defective ventricular lead is still partially functioning?

There is no doubt if it is still functioning but defective that muscles and nerves could be adversely stimulated and that you might feel symptoms in your armpit. 

You need to speak to your team to find out what has happened.  They may be able to adjust your lead settings ?atrial or ventricular? (turn them down if they are set too high) to help prevent your discomfort.  However, if we are speaking about the defective lead and you need a degree of ventricular pacing, I am surprised that they didn’t replace it at the time of your device change.

Lead answer

by jfasoneholder - 2023-12-31 12:14:43

My ventricular lead is still partially functioning so they left it in. I pace almost only in my atrial lead so we decided not to extract it or cap it. After the new PM was put in, I started to use the ventricular lead at 25% when before it was 3%. 

Very strange

by Gemita - 2023-12-31 12:35:02

You clearly need ventricular pacing sometimes and I am surprised they didn't take the opportunity to replace the defective lead at device change.  If they cannot stop your discomfort with further adjustments, I would ask whether the defective lead can be "safely" turned off.  If not, whether a new lead needs to be implanted? 

I wonder what percentage time you are pacing in the right ventricle now after those adjustments.  Do you know?  I am mainly atrial paced (98%) but I still need ventricular back up sometimes to keep me safe (my ventricular pacing can range from 1% up to 9%).

I hope your symptoms can be relieved with an adjustment to your settings.  

Heart beat in arm pit

by Selwyn - 2023-12-31 14:39:13

The fact that you feel a pulse in your arm pit may be for a number of different reasons. It is unlikely that you would feel a heart beat.

1. I found that unipolar setting caused muscle twitching. Make sure the new setting is bipolar

2. If there is an electrical leak ( eg. a fratured lead), this can cause muscle twitching.

3. Sometimes anxiety can cause enhanced body sensations. 

4. Nerve damage.

5. Least likely is injury to the axillary artery.

So, the short answer to your question  is number 2.  How you prove this is another matter!

Rings a bell

by piglet22 - 2024-01-01 05:44:21

Selwyn has given probably the closest explanation for this from a pacemaker point of view.

It's something I personally experienced when my first device (Medtronic type unknown, early 2000's) was heading for replacement after nearly 11 years use.

I have described it before, but basically I started having pectoral then left arm "twitching" at what was undoubtedly the same frequency and timing as my heartbeat.

At first I thought it was some purely nervous reaction like an eyelid twitch, but it showed no sign of stopping.

Putting two and two together, low battery, frequency, it had to be the pacemaker and and something had happened.

After a short and futile conversation with NHS 111, I ended up in A&E.

A senior paramedic said a pacemaker couldn't cause muscle twitching. So much for that advice.

After about 4 hours, the on call EP turned up, told me that the device mode had changed and made some adjustments to reduce the twitching.

Next day, the device was replaced.

Not an experience I would want to repeat and in my view, avoidable.

I don't have a confirmed explanation, but clearly some or all of the pulsing voltage/current was leaking and because of the location of the twitching, it had to come from the device.

I still have the original leads (dual chamber), so lead failure wasn't likely.

Had the pacing polarity changed?

Was the voltage ground and signal somehow reversed?

I had read somewhere that early devices used muscle twitching as and end of battery life indicator.

Clearly, pacemaker leads are more complicated than a bit of wire stuck into heart muscle and shielding and grounding is paramount.

Certainly what you can't do is rely on advice that it can't happen because it does.

What you have to beware of is the fact that very few medics will have come across this sort of situation first hand.

It definitely hasn't done much to boost my confidence in device monitoring or cardiology replacement policy in my health trust at least.

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A pacemaker suddenly quitting is no more likely to happen than you are to be struck by lightening.