heart block and pacers

First time I saw a cardio and the pacer was tested he bounced into the office saying I had a couple of heart blocks (why it was inserted) that the pacer had taken care of. Second time, same office but a tech said "oh, you can't tell whether you have a heart block now as the pacer takes care of it", third time an EP said no heart blocks. I asked him if we could take out the pacer, and he said probably not a good idea as it did do a little ventricular pacing (2%).

I sure wish people would tell me the same thing about this. Can you tell from the data whether there is heart block it has taken care of or not?

Thanks --

Judy

4 Comments

odd

by Tracey_E - 2011-06-19 05:06:38

Something doesn't add up here. Third degree means all the signal doesn't get through all the time. Second and first degree means all of the signal gets blocked some of the time, or some of the signal gets blocked all of the time. Example- you go between beating properly all the time then for a few minutes go into complete block and the ventricles beat at random. OR a 2:1 block means one signal gets through for every two beats all day long. Or any combination thereof. How often it happens determines if they call it 1st or 2nd but it can change so sometimes they just slap a label on it.

The pm doesn't care which it is and it fixes all of them. It's like a watch dog always there. Every time the atria beats, it watches to see if the ventricles follow. If they don't, it generates a pulse to cause a beat. I have 3rd degree block and pace 99.5% of the time, which is typical for 3rd degree block. Did I read in another post that you had an ablation? If you did, maybe you were in 3rd degree at the hospital but now it's only occasional? That can happen after an ablation.

Not too comfortable, as in you felt bad when it happened, or as in you don't like knowing it's dropping? A little piece of advice I often give the newbies... if you feel good, quit counting your pulse, bp, etc :o) It gets way too easy to obsess and look for problems that aren't there. If you feel good, assume you're pacing properly.

That said, I would ask them to check your settings, they should be able to prevent drops like that. If your min is 60, that means it will kick in and pace ATRIAL if your atrial rate drops below 60. Ventricular pacing, it doesn't really care how fast you're going, only that you're beating in sync with the atria so your upper limit is actually the important number for ventricular pacing. It will only pace ventricular up to the programmed rate, usually 120-130.

Usually with a block the atrial rate is normal and lower limit is irrelevant but it sounds like you've got something more complicated than a simple block. What it sounds like is happening... your atria is going at 85, your ventricles are either keeping up on their own or pacing, doesn't matter which. Occasionally the atria drops. If it drops below 60, the atrial lead will kick in and keep it at 60. As long as it's over 60 it's just going to watch. As before, the ventricle lead is only watching to see if the ventricles are keeping up, only pacing if the atria beats and the ventricles don't follow.

They can program it to prevent sudden drops rather than only have it set to kick in below 60, but unless they know that happens it's probably not set to catch it. I had something similar happen, my hr would occasionally tank when exercising. They turned on something called rate drop response and now it's fine.

Hope this makes sense! Here's a great video that explains how the heart beats and how the pm works
http://health.sjm.com/arrhythmia-answers/videos-and-animations.aspx

Thanks

by judy13 - 2011-06-19 06:06:02

That all helps some, or adds to my confusion -- whichever.

It was explained to me that on 1st and 2nd degree the signal was slow getting to the ventricles, on 3rd degree it didn't. I had double checked that when I got home and the article on emedicine seems to be saying a similar thing when it says
"In most cases of persistent third-degree AV block, permanent pacing is required"
By referring to persistent 3rd degree, I would gather there is intermittent 3rd degree which seemed to be what I had. I would flat line in the hospital. Everyone would rush in and I would recover on my own. This would happen multiple times per night. They kept me prepped for paddles but I didn't need them. They would eventually put me on an adrenalin drip and take me off of that during the day so I have no idea whether it would have kept happening during the day without that drip. They sure don't like to keep you on it though.

I had always had tachycardia, not bradycardia so really didn't need a pacer for that.

I will look into the drop rate and see if they can set it. The reason I was watching the pulse was because I was feeling poorly and I wanted to know what was going on. It is the only time I have seen it, but then usually I am not near the pulse ox when I am not feeling well. I do know from having afib having large variations in your pulse rate can make you feel lousy.

pacing

by Tracey_E - 2011-06-19 10:06:30

When you are pacing ventricular, that's when you are in a block, so you spend about 2% of your time in a block. Yes, the pacer takes care of the times you are in block, that's what it's there for. You won't feel when you're in block now and just listening to your heart or counting your pulse it would be impossible to tell if you are in a block, but if you were hooked up to an ekg you'd tell easily because of the pacing spikes and there's a record of it in the pm memory. So, they're all telling you the same thing more or less, just in different ways which makes it confusing. Clear as mud? :o)

3rd degree heart block

by judy13 - 2011-06-19 12:06:13

Thanks -- and sorry. I had just written my intro so see that I didn't say exactly what I wanted to in the above question. I had 3rd degree heart block, when no signal gets through. As I understand it 1st and 2nd degree it is somewhat slow getting through, and in fact with mine they tried to set it so it wouldn't fire on the 1st degree generally.

It sounds from what you are saying they can't tell what kind of heart block it is firing for? Actually that makes sense to me as it would fire before you got to nothing.

I was following my pulse once on a pulse ox, and it was going along at about 85, tanked to 59 (my low setting is 60), went back up to 85 or so, then tanked again. I figured that was the pacer kicking in. Not too comfortable to have that variation actually. -- Judy

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