Diaphragm contractions

Hi. I received a dual chamber PM 2 days ago (my first) and during the second night of sleep had "chest contractions" which were strong enough to wake up my wife. The contractions were infrequent but I decided to go to the emergency room at the hospital. It was determined that my diaphragm was picking up an electronic single from the cardiac pacemaker and causing my diaphragm to contract. Has anyone heard of this condition? Can it be resolved by changing programming settings in the PM? Are the leads in the right place? Any advice would be greatly appreciated. DT

6 Comments

PM Problems

by SMITTY - 2008-03-15 06:03:11

Hello DT,

Welcome to the world of pacemakers and to the Pacemaker Club. Many of us have experienced the symptoms you describe and there are just as many possibilities for correcting the problem. I was luckier than you, your problem started on the second day and it was three weeks before I had my first experience with diaphragm contractions. Mine not only caused the "chest contractions" you describe, but I had the hiccups as well. It may take several visits to get an improvement but changes in PM settings can usually solve the problem. But because each of us is so totally different, it is truly trial and error in finding a solution.

The cause can be any one of the items you list, or it can be a case of where the electrical impulse from your PM to make the heart chamber contract is finding a line of least resistance to the nerve affecting the diaphragm. Since I was having a problem with what I described as "explosive" hiccups (they were unbelievably loud and sudden) and what felt like an electrical shock in the lower part of my chest on the right side. I finally said enough is enough and more or less demanded that my PM be turned off. I knew I was not PM dependant so while the doctor objected, I thought I would be no worse off than before I got the PM. I knew it was a gamble, but it worked, A couple of years later when it was restarted to try and solve a short of breath problem the shocks and hiccups came back but the visible chest contractions did not. I got two offers to solve my problem. One was to reposition the lead in the ventricle and the other was to try an injection to deaden the affected nerve. By then the lead had been in place 5+ years so I opted for the injection. That worked and 2.5 years later it is still about 75% effective. The fact that the effects are wearing off is not surprising as I was told at the time there was no guarantee it would work at all and if so no one knew for how long.

Now getting your problem solved maybe very easy and simple, but it may also be a trip through hell. From what I have learned about pacemaker problems, many doctors are prone to try to convince us the problem is not caused by our PM. My opinion is that "the problem is not your PM" is tried because they simply do not know what to do and they hope the problem will solve itself. The problems do go away on their own occasionally, I guess, but more often than not some PM change is necessary.

As for you, I am going to make an uneducated guess that a change in power settings may be what you need. (I just read Frank's message and becasue of his superior knowledge about these things, I'm not trying to say my guess has a higher probablility of being correct.)
I say this because your PM is new and the settings we get at the beginning are truly guesses. An educated guess I'll grant, but still a guess. So don't let up on your requests for help. As I've said too many times, I know, but with a PM it is often a case of the squeaking wheel getting the grease.

If possible please let us know how things go. We all learn from the experiences of others.

Good luck,

Smitty

Unipolar mode

by ElectricFrank - 2008-03-15 06:03:19

It sounds like your pacer is in unipolar (or monopolar) mode where the returnd path fro the pacing pulse is through body tissue. Any muscle in the path is likely to twitch.
Normally modern pacers are operated in bipolar mode which doesn't have this problem. The 2 most common reasons for the unipolar setting are that it wasn't programmed correctly or that there is a bad lead which causes the pacer to change modes as a fail safe response. Some doctors will try all sorts of adjustments to get around having to replace or relocate a bad lead. Now is the easiest time to have it fixed before the lead scars into the vein wall. Request a check of your pacers settings and a printout. There should be an entry showing the mode and also one showing the condition of the leads.

frank

Unipolar mode

by DT - 2008-03-15 06:03:30

Hi Frank. Thank you so much for your response. I suspect that the implant was inserted "factory default mode" since it was done on an emergency basis by a thoracic surgeon (the vascular surgeon was on holidays - small town!). I will call the cardiac clinic on Monday to find out if it was set in unipolar mode. (I have an appointment March 24 for a full assessment which I suspect will tailor the PM to my specific needs). Again, thank you quick response. DT

Ask your PM Doc or Tech.

by dward - 2008-03-15 08:03:37

As you have read, your condition is actually more common than one would expect.
There indeed several different possible causes, power settings, polar mode, too close to a nerve, etc.
Best thing to do is ask your PM Doc or PM Tech. They can run tests to see what the probable cause is - which is better than any of us guessing.

Nice to know that it's not uncommon though!!! (At least is was comforting for me.)

Diaphragm contractions - voltage set too high

by DT - 2008-03-18 12:03:57

Hi. I had my PM checked at the clinic and they could not replicate the "diaphragm contraction" condition. The PM was reset and the voltage to the leads reduced. Problem disappeared. I have the settings checked again next week but all appears to be fine.

Thank you for all of your comments. It really helps to provide us newbees with comfort knowing that others have experienced similar issues and are willing (and able) to support others. God Bless you all!

Diaphragm contractions

by JudyW - 2008-11-09 09:11:42

HI everyone. I had my pm implanted on 9/16 after years of fainting from time to time. The last time was on 9/12 when I met friends for lunch and passed out. I was taken by ambulance to the nearest hospital and while hooked up to a heart monitor I passed out again and flatlined for 45 seconds. I was immediately rushed into cardiac where they put in a temporary pm and a permanent one three days later (it was a weekend).In the past there had been no definitve cause for my syncope other than possible seizure syndrome which I never believed. I even had a VERY extensive EEG done by a leading neuro in a prominent teaching hospital. He said there was no way that it was seizures. That was in 1999. Over the years after that I would get this deja vu feeling and pass out or almost pass out. I never ever would have thought it was a heart problem. On 9/12 I passed out or almost passed out a total of six times that day. Fortunately a cardiologist was present when I flatlined and was able to diagnose SSS. Everything was fine after that until 9/29 when I started having a fluttering feeling then later that day the jumping diaphram started. I went to the ER and a Dr. said that a wire was causing the problem. On 10/2 I went back in and they reopened the incision and repositioned the pm. So far no problems. Excellent Doc...it looks like only one incison not two.
I found it interesting reading throid problems on here. I have been on thyroid meds since I was 22. Hmmmm is there a connection?

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