side effects of PMs

Hi everyone,
Ive just come back from a regular PM check (in the UK) and was told that I am being paced about 25% of the time. The doctor said this was 'good'- I said, 'why- because my battery will last longer?' and he said, 'yes, but also because your heart is unlikely to be damaged by pacing at this level'.

I didn't ask for any more details at the time but now I'm starting to wonder about what he said. This is the first time I had heard of this- perhaps I have been living in a dark cave and missed something- and of course I dont have a choice because the PM has to stay and has made my life infinitely better- but I wondered if anyone else had heard of the type of damage that can be done when people are paced frequently, and anything that can be done to limit damage?

thanks for any info!!
Jackie

9 Comments

I don't think so

by boatman50 - 2007-11-07 01:11:34

I have asked that question when seeing both the cardiologist and the EP. Both of them have said no, there would be no damage to the heart. And as you say, what are you going to do anyway?

Hi,

by Gellia2 - 2007-11-07 02:11:05

I found out a little bit about this just recently. It seems that they are finding that the more the right ventricle is paced the higher chance of congestive heart failure and left ventricular hypertrophy. I found this information out when I had the impedance check feature turned off in my Medtronic Enpulse pacemaker. I pace the ventricle all the time so checking to see if it was necessary was unneeded and causing me a problem. That said, I have been 100% pacing my right ventricle for over 32 years now. Not to say it can't happen, and my dr is always on top of it, but I have only had slight CHF and no LVH.
This is just being studied as we "oldsters" in the pacemaker world are just starting to find these occurring problems.
Hope this helps!
Best to you,
Gellia

Heat Damage From PM

by SMITTY - 2007-11-07 02:11:31

Take a look at the article below on this subject. Also, be sure you notice the date of publication. This is they only information I can find on this subject. Also, this talks about "defibrillators." However, if you look further you will see the author is describing the function of a dual chamber pacemaker which he calls a defibrillator. Seeing a PM referred to as a defibrillator is new to me and frankly I think the person writing the article got his devices mixed up. Be all that as it may, from what I can see a PM/ICD that causes damage to the heart is one that is not properly adjusted.

I have had the problem of my PM being out of sync and I can say for certain it does cause pain, but not severe pain. It is just what I call an attention getter. The first time it happened the rate response feature on my PM was activated and when I had it turned off the pain went away. Now, within the last 3 or 4 months I am having the same problem again and the rate response is not on. At my last checkup I mentioned this was happening and the nurse technician said nothing but did look at me like she was thinking "this old fool does not know what he is talking about." The result is nothing was done and the "attention getters" are becoming more frequent and when it gets to be a problem I will find a way to get it corrected.

When it is all said and done., if I hear my PM is damaging my heart, which it may be doing because it is out of sync right now, I'll not blame the PM. To me it appears this may happen if it is not adjusted correctly and that is a human induced failure.

Now don't any of you misunderstand me, I've cussed my PM more than most people because I didn't need it when it was implanted and then the thing hurt me by shocking me for several. But I blame none of that on the PM. All of my problems were caused by humans that were being paid to prevent such things from happening.

I think the only problems caused by a PM are those where the PM (or defibrillator) failed and in some cases caused the death of a person. While that has happened, it is extremely rare so far as I know. I have no doubt that PM/ICD units have kept many more people alive than they have harmed.

Smitty

Study Links Heart Damage to Pacemaker

Published: December 20, 2002
The common practice of pacing the heartbeat may damage patients' hearts, researchers said today in a study of heart devices that was terminated early because too many patients died.

The Cleveland Clinic cardiologist who led the study concluded that physicians should switch off the pacemaker function on dual-chamber implantable defibrillators because it may knock the heart out of rhythm and hasten heart failure. The pacemaker uses a mild electrical impulse to continuously control the heartbeat.

Defibrillators are implanted in about 100,000 people a year to control irregular heartbeat, which is often a precursor of a heart attack. The device delivers a powerful shock to the heart if it falls out of rhythm or speeds up too much.

Many of the battery-powered defibrillators in use can deliver electric shocks to both chambers in the heart's right side, which pumps blood to the lungs. The left side of the heart pumps reoxygenated blood returning from the lungs back into the body.

In a majority of patients with the implanted dual-chamber defibrillator, the device's pacemaking function is also activated. But activating the pacemaker function in the right side of a patient's heart may be throwing off synchronization with the left side, causing the heart to lose efficiency and deteriorate, said the report, which is to appear next Wednesday in The Journal of the American Medical Association.

''It's easily conceivable that, with the number of defibrillators going in, if three-quarters are being programmed the wrong way, we could be hurting patients,'' the lead author, Dr. Bruce Wilkoff, said in an interview.

Of the defibrillators implanted in 506 patients in the study, half were programmed to pace the heart at 70 beats per minute as well as to shock both right-side chambers in the event of an arrhythmia. The other half were programmed to shock the right ventricle in the case of an arrhythmia but only to activate the pacemaker function if the heartbeat fell below 40 beats per minute. (The normal range is 50 to 75 beats a minute.)

In the study group whose pacemaker function was activated, and who were expected to be healthier, 23 died and 43 became ill enough to require hospitalization. In the other group, 15 died and 30 were hospitalized.

That was enough for a committee overseeing the study to call a halt a few months early, before more patients were enrolled.

A spokesman for Medtronic Inc., a leading manufacturer of defibrillators, said the study was flawed because the patients who participated did not need their hearts paced for them. ''Physicians know when the patient should have pacing and when they shouldn't,'' the spokesman, Scott Papillon, said.

The devices used in the 506-patient study were made by St. Jude Medical Inc., which paid for the study, Dr. Wilkoff said.

He said pacemakers, which have been around for half a century, still have an important use for patients with ailments that dangerously slow their heartbeats.
But patients with defibrillators who do not need the pacemaking function should probably not use it, Dr. Wilkoff said. The problem, he said, is that many patients who have the devices also take medications that slow their heartbeats, making them sluggish and candidates for the pacemaking function.

The next generation of heart devices delivers impulses to both sides of the heart to ensure synchronization, he said, though implanting electric leads on the left side was more difficult.

Something else to think about

by ela-girl - 2007-11-07 04:11:59

Hi, Jackie.

Another thing I was thinking about regarding this topic that was told to me by my EP and tech is that the heart can become a little bit lazier with a pacemaker. Pacers who don't pace 100% of the time will notice over the years that they are being paced more and more. I am told that this is because the heart is used to somebody else doing its job and it basically gets lazy. Maybe this is what your doc meant by "damage?"

Just an idea!
ela-girl

News to me.

by sweetkozy - 2007-11-07 12:11:04

Hello Jackie,

I am just as surprised by this as you are! I have never heard it can damage the heart being paced more frequently. I've been paced for 5 years and have been running between 45%-78% of the time pacing. I hope it doesn't cause damage, but then again what are you to do - not be paced? I hope someone can answer this as I am just as curious as you are. Great question!!!! Now where's Smitty.....I'm sure he'll find the answer out for us all!

Cheers,
Jenny

Not sure......

by Suze - 2007-11-07 12:11:47

I'm not sure I want the answer to this one, since I'm paced 99%. It might be scary! But the alternative is much worse, I'm sure.

I could look it up myself, but not sure where to go first. Or if I really want to know. Does that seem like I've got my head in the sand? (Is that expression worldwide?).

Suze

yes like an ostrich

by jessie - 2007-11-07 12:11:48

i don't know the answer so it can't be bad becausepeople live for years with pacemakers. i cansee how the panic mode might strike tho with a comment like that.wait and perhaps smitty will enlighten us. jessie

RV pacing issues...

by Angie_O_Plasty - 2007-11-08 09:11:47

I actually just read an excellent review article about this for school. Basically the problem is that when the right ventricle is paced from the apex (which is the bottom part of the ventricle and is where the lead is generally placed) the two ventricles contract slightly out of sync and that can weaken the heart--it's the same kind of thing as having a left bundle branch block which also creates problems. The article suggests that alternative lead placements in the ventricles need to be looked at, including wider use of the newer biventricular devices that keep the ventricles in sync or putting the RV lead in a place closer to the bundle of His so it more closely mimics the way the electricity travels in the normal heart. I don't have the article with me, or I'd post the citation for anyone interested. It's in the journal "Pacing and Clinical Electrophysiology" and if you go into the e-journal and search for "right ventricular apical pacing" you'll probably find it.

insulation break and perforation

by Loeke - 2008-02-20 12:02:28

I received a St. Jude 5386 pm in December 2006. From the beginning I had something that felt like a "tic" at the pm site. The cardiologist and the tech told me it was just "settling in." It got worse over the year, and I learned to make it stop by holding in a certain position. It got increasingly difficult to do that and a new sensation cropped up: it felt like a cell phone on "vibrate" only less intense, also at the pm site. 10 months after the implantation an impedance check was done and showed that the atrial lead had dropped to 45% of its implant value.

When the cardiologist tried to replace the atrial lead, he perforated the atrial wall with the new lead, which generated cardiac tamponade and required open heart surgery to stop the leakage.

I am also now experiencing discomfort at the site whenever I cross my arm gently over my chest, and sometimes it feels like there is a pricking there. Has anyone had a similar experience to either of these?
Loeke

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