Heartblock

Hey Everyone,

I'm putting this question out there to all of my pacemaker friends. Yesterday I went to my checkup for my PM and found out that the bottom half of my heart is using the PM 97%, where at my last visit 6 months ago it was only 32%. When I asked the Cardiologist why his reply was, "It doesn't matter why, since you have the PM it will handle it whether it's 32% or 97%." Am I wrong to want to know why my heart needs it more now than 6 months ago? I am a 46 year old woman, and the reason I have the PM is due to a botched ablation, where the main nerve in my heart got damaged, resulting in heart block so I had to get a PM. My EP said that the heart block might go away, yet I find that my heart is using it more? Anyway I'd love to know your opinion. Thanks for reading!
Sue

4 Comments

ventricular pacing

by golden_snitch - 2010-02-07 03:02:18

Hi there,

could be that you have some "unnecessary right ventricular pacing" which means that the pacer is pacing your right ventricle although it doesn't really need to. That's a common problem in patients who do not have a permanent third degree heart block. It depends a lot on how the pacer is programmed. If the relevant settings are programmed carefully, one can avoid too much ventricular pacing. One of the important settings is the AV-delay. If it's programmed too short, then the ventricle hardly get a chance to beat on its own (wait for the impulse from the atriums to "arrive", if your AV node is not destroyed completely, some impulses will still pass through); the pacer will kick in too soon. I have heard that some cardios just don't optimize this setting - either they don't know how or they just don't care.

Well, as Smitty said, the pacer doesn't care whether it paces you 30% or close to 100%, except for the battery life being a bit shorter when you are paced all the time. But your heart cares. Too much right ventricular pacing can lead to heart failure and might cause atrial fibrillation. Now, up until now this risk cannot be reduced in patients who really need 100% ventricular pacing (unless they are given a CRT device) but it can very well be reduced in patients who don't have permanent heart block. All pacers have special algoritms that are supposed to minimize ventricular pacing. But as I said, they need to be programmed carefully. So, if you've got a doctor who says it doesn't matter and who probably just leaves the factory settings, this might be the problem.

Your EP and Smitty are right that the heart block might somehow go away. But it could also worsen. I have had a so-called slow-pathway modulation in my AV node. After the ablation I had no problems for years, but than after about six years I developed a heart block, and my EP said that it might be caused by the scar tissue from that ablation.

Hope this helps a bit.
Best wishes
Inga

Maybe This Will Help

by SMITTY - 2010-02-07 03:02:26

This shows my old age or dumbness or something, I guess,. I answered your question the best I could then posted it in the wrong place. I sent it to Suemarie first. Still hope it helps some.


Hello Sue

I have a question before I comment. The doctor that said "It doesn't matter why, since you have the PM it will handle it whether it's 32% or 97%." the same doctor that did the ablation?" If it is I would take a dam dim view of his cavalier attitude. Even if he didn't do the ablation, I would be offended by such reply.

But he is correct, the pacemaker doesn't care if it is sending impulses 1% or 100% if the time. Of course the battery life will be shorter if it is 100% but still good for 5 to 7 years.

I would not put to much emphasis on the fact there has been such increase based on the results from one checkup. Wait until your next checkup and see what the Reading is then. If it is still close to 100% then that may be the norm for you since the botched ablation. However, don't let that convince you that you will die if anything happens to that pacemaker. The high percentage could be partially due to the settings on the PM. In other words they are set high to give you opium results, and as such the PM works essentially all the time. Where as with a lower setting your hearts natural pacemaker (yes, it still has one even though you have had an ablation) could get in the game once in a while and the percent use by the PM would be lower. Even if the pacemaker did quit, our heart will not give up so easy as it has a backup natural pacemaker. That backup can keep you going for some amount of time. You will not feel like running a marathon with the backup keeping it keeping your heart working because you heart rate will be very slow.

As for the block going away, that is entirely possible, although it may take many months. The node that carries the hearts natural pacemaker impulses is a strip (for lack of my knowing a better word) body tissue and like most body tissue it can heal itself after being wounded. Also, just like any other wound, the healing is a slow process and in meantime your pacemaker will continue to pickup any slack needed.

If I may offer some advice, yes you have a problem and any time you think something is amiss with your pacemaker call your doctor. However, in the meantime don't spend every free moment trying to analyze what is going on with your heart beat and the way you feel. While you have a problem you are wearing a cure for that problem and that cure is not going to let you down.

I wish you the best,

Smitty

Dr.

by twilkie - 2010-02-07 07:02:44

Hi Smitty,

No it was not the same Dr. that did my ablation that made that rude comment, it was my Cardiologist. I think it's hard for them to remember sometimes that they are talking to real people, not just a chart. Thanks so much to all of your responses, I'll say it again, I am so grateful for this website and all of the nice people on it:)

av block

by srar - 2010-02-11 07:02:02

Hi Smitty,

Doctors say that damaged AV Node during abalation could recover from what I hear chances of recovery is 1%.

Once you are in a 3rd degree block you will be paced 97%. I am on the same boat as you are hearing the same answer from doctors.

Best Wishes

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