I need to know what to expect.

Hi there,

After three and a half weeks of my PM implant, I decided to go to the beach. Even though I was very careful following Drs. advices, I just came back with my arm soaring. Somehow I was expecting to fell my heart beat about the same as before, but that did not happened.

I have noticed I don't get that tired, but when I make some kind of effort beyond walking, seems like my breathing gets out of pace, somehow feels like it looses sync.

Is there a day when you feel as before, or you have to get use to learning a new way of living?

On the other hand I found out my ventricular estimulation is at 100%. Is that normal for a level 2 heart block?

6 Comments

New PM

by SMITTY - 2008-10-19 11:10:15

The following is long, but it is the best description of what to expect after getting a pacemakerr I have found. Maybe itwill answer some questions for you as it did me.

What happens after the pacemaker insertion?

Depending on the patient’s age and overall health, a short hospital stay may be recommended following permanent pacemaker insertion. The physician will provide specific instructions regarding the patient’s appropriate activity level immediately following the procedure. If there are no complications, complete recovery from the procedure will take about two to three weeks. During that time, the wires will firmly take hold where they were placed. In order to help keep the wires from becoming dislodged, patients should avoid contact sports, heavy lifting or vigorous movements of the arm on the side of the pacemaker.

Patients should not be alarmed if a hard ridge forms where the incision was closed. This will fade away as the wound heals. However, any signs of infection (e.g. fluid leakage) should be reported to one's physician immediately. A warm compress can be used to reduce any pain in the area. Patients can bathe or shower normally, being careful to gently wash the incision area with mild soap and then pat the area dry.

A follow-up visit at the physician’s office is usually scheduled for one to two weeks after the implantation. At that time, the sutures or staples are removed (if necessary), the incision site is inspected for signs of infection. The patient will receive further instructions for living with his or her pacemaker. This includes carrying a pacemaker ID card at all times in case of emergency. There will be a follow-up visit to the physician about two months later, and then every six to 12 months, to ensure that the pacemaker is working properly.

In between visits, pacemaker checks may take place over the telephone, through transtelephonic monitoring. Through a special device, information from the implanted pacemaker can be sent over the telephone. A trained medical professional then evaluates the information and relays findings to the patient and physician. These transtelephonic checks are scheduled every two to three months. If programming adjustments are needed or battery replacement is necessary, an appointment for an office visit will be made.

What are the risks during or after pacemaker insertion?
As with any surgical procedure, there is a risk of infection with permanent pacemaker insertion. Surgical risks are higher if the patient has high-risk characteristics such as the following:

What are the lifestyle considerations with a pacemaker?
Following the insertion procedure, patients will be given a card providing basic information on the implanted pacemaker as well as emergency instructions. This card should be kept with them at all times. In addition, patients should memorize their pacemaker make and model number. Although mechanical problems are rare, this information will prepare patients in the event of a pacemaker recall by a manufacturer. Patients may want to wear a medical alert ID bracelet or necklace that provides information about their heart rhythms and pacemaker, as well as an access number for their medical files.

Patients should know the rate at which their pacemakers are set and then take their resting pulse rate for one full minute each day, contacting their physician if their pulse is five beats or more below the programmed rate. A faster rate is not a concern unless it is more than 100 beats per minute at rest. A program of daily moderate exercise is also recommended. Patients who want to exercise more strenuously will need to speak with their physician about designing a healthy exercise program. All patients should consult their physicians before starting to exercise.

Starting about two to three months after implantation, patients will have regularly scheduled pacemaker checks with their physicians every six to 12 months, depending on the model that was implanted. These visits may include a medical history update, blood pressure check, x-ray, electrocardiogram (EKG) and/or a stress test. Both the programming and the battery strength of the device will be checked by a radio transmitter that is used to communicate with the device.

What devices interfere with pacemaker operation?
There are many myths about electrical devices that could interfere with pacemaker operation. Home security systems, for example, do not pose a significant risk to people with pacemakers (although patients who are concerned can contact the system manufacturer for further reassurance). Furthermore, most common household appliances in good repair such as microwaves, cordless phones, electric blankets, electric shavers, CB and HAM radios, heating pads, televisions and remote controls, computers and hair dryers do not pose a significant risk to pacemaker operation. While some of these devices have been found to cause interference with an occasional single beat, they have not been found to change or inhibit pacing rates. Patients should discuss their concerns regarding these or other devices with their physicians. It is also vital that patients inform their health care providers about their pacemaker before any medical or dental procedure is done.

Although newer pacemakers have better insulation that makes them less susceptible to interference, some devices can still affect pacemaker operation. While this interference is rarely life threatening, caution is recommended around the following:

How long will a pacemaker last?
Since the battery of the pacemaker is sealed within the generator chamber, the entire chamber is replaced when the battery is low. Most modern pacemakers use lithium batteries that need to be replaced every five to 10 years, depending on how dependent the heart is on the pacemaker.

Pacemaker batteries will not run out unexpectedly. When a battery is running low, the elective replacement indicator (ERI) is activated. Physicians can detect this activation during a routine office visit. In addition, the battery status and the general functioning of the pacemaker can be tested over the telephone. This is generally done every one to two months. Pacemakers will continue to function for approximately six months after the ERI is activated, allowing ample time to schedule an elective replacement procedure.

Day at the beach

by ElectricFrank - 2008-10-20 01:10:19

What sort of activity did you do at the beach? Just spending time at the beach shouldn't be any problem, but swimming might be a bit too strenuous this soon after surgery.

The most likely possibility is that you irritated the surgery site. It is also possible that you dislodged a lead, but this is unlikely.

Oh, one other possibility. If the pacemaker has rate response turned on and it isn't adjusted right for you, any activity like running on the beach might send your HR soaring. Rate response is one of the ways the pacemaker adjusts your HR to your activity.

I suggest calling the doctor and having a checkup.

frank

New PM and day at the beach

by oscarp727 - 2008-10-20 10:10:23

Thank you Smitty for all these important information. It seems like I need a longer chat with my physician. I didn't receive nearly 50% of the information you are giving me. To start with, I haven't heard from my doctor the exact diagnostic beyond a level two heart block.

Frank, I didn't do any swimming or other physical activity involving moving my arms. I am kind of careful knowing the risks involved around the wires.

I did carry stuff with my right arm being cautious not to exceed to much weight.

I had my brother in law take my boat to the lake for a ride and I was on the wheel probably for half hour, again trying not to use my left arm.

The thing is, during that time, there were moments were my breathing was out of pace, even feeling breathless sometimes.

As you can see I am very new in this issue and my terminology I am sure lacks knowledge.

Thank you.

Sense of pacemaker

by ElectricFrank - 2008-10-21 02:10:35

Maybe your printout will give some idea of what is happening. A level two "heart block" is actually a level two AV block which means that the electrical signal from your atrium to ventricles is unreliable. A level two means it is working part of the time. I have a level three which means it is kaput all the time. All the pacer has to do is sense the atrial contraction with one lead and use it to time a pacing signal to the ventricles. It is just wiring around the defective AV conduction bundle.
In your case the pacer has to decide whether the next beat is going to make it on its own or does it need pacing. This involves some tricky programming so the process runs smoothly. If it is set wrong you may skip a beat or even two once in a while. Then the cardiologist gets panicky and turns on the rate response which totally takes over pacing both atrium and ventricles. With a good natural atrial pacing system of your own this can create a conflict between the pacer and your heart.
I had this at one point early on and it wasn't very comfortable. After analyzing my printouts I had to lay down the law to the cardiologist. The Medronics rep told me (on the side) that I was right.

By the way your terminology is fine. You are describing what you are feeling. I have the same problem. The doctor likes to ask do I have any shortness of breath and I have to tell him I only get "long of breath" which is what I do anytime I feel strange.

frank

Rate response

by oscarp727 - 2008-10-21 10:10:08

I just checked my print out and the rate response is activated. That is something I will discuss on my next visit to my cardiologist.

Your explanation was very helpful and confirms must of the reading I have been doing these days. Also the term "long of breath" couldn't be more accurate.

Did you began with an AV block level three from the start or it evolved from a lower level (level one or two)?

Oscar.

Level 3 block

by ElectricFrank - 2008-10-22 12:10:46

Mine started with a bang! One afternoon between xmas and New years 2004 I was feeling lousy. I decided to check my BP and while it was OK my pulse was 40. I tried jumping up and down for minute or so and still 40. At that point I knew I had a problem. I had my wife take me to ER with the idea of getting an ECG run. The ER was full of people with the flu and they had a delay of several hours. At that point my wife and I talked it over and decided that we were willing to risk the situation getting worse, and felt I didn't need to pick up a case of the flu on top of a cardiac problem.

We went home and went to bed and set the clock for 1 hour. I would wake up and check my pulse to see if it was getting lower and then go back to sleep. It stayed about the same all night. Next morning I got an appt with our GP who has an old analog ECG in his office. It was obvious from the ECG that my ventricles were doing their own thing, but my atial beat was responding to exercise which is a pretty good indication of AV block. Any conduction was totally missing making it a 3rd degree block.

I went from their to a cardiologist who arranged for an implant on New Years eve. By the time I got the implant my HR was down to 26BPM and I was still able to stand and walk without passing out. I just felt crappy. I had the implant done with a local anesthesia and no anti anxiety meds. It was interesting listening to the conversations in OR and feeling the pacer being turned on.

The block is still pretty much the same. About 6 months or so ago at an office check I ask the Medtonics rep to turn the pacer off for a short time to see where I am. My HR dropped to 30. He asked me to tell him if I felt like I was going to pass out and I finally stood up and still stayed conscious. This is one of those "longness of breath" times. So I know that while I am considered 100% dependent I won't pass out or die if the pacer quits.

By the way my guess is that the feelings you have been experiencing is due to the rate response. Does the printout show what was changed at the last checkup. Mine shows changes in a line that looks like Rate Response Off>On showing that it was changed from off to on at that session.

frank

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