Pacing better

I'm 54 and had my pacer put in on July 15, 2013. At that time, I was told I had 3rd degree heart block. The doctor told me that only 20% of the signal from my Atrium was getting to the ventricle so my heart rate was going down to the 20's at times. Everything came on quite suddenly, though there were small signs (some lightheadedness for months before). Also, in April, and in the hospital, my liver enzymes were elevated, probably because my heart was not pumping enough- now, my enzyme levels are normal. The few days before the implant, I had multiple episodes of near fainting and severe exercise intolerance. All this to say, that when the pacemaker was put in, it was considered an emergency. I was told that there was a chance that I had Lyme Disease but didn't have time for the treatment. If it turned out to by Lyme, I could have the pacemaker taken out later. After a few glitches in my settings (they had the rate response on for the first few weeks, which elevated my pacing) I have settled into pacing 12% Atrium, and 10% Ventricle with the lower heart rate setting at 50. Today, my cardiologist took yet another blood draw for Lyme disease (two others were negative) and lowered my heart rate setting to 40 in the hopes that I would not pace at all, or very little. He still thinks that I may have Lyme. I think I damaged my electrical system during 4 years of heavy marathon training, though my two cardiologists think this improbable. I'm wondering if others are pacing quite low like me after being diagnosed with 3rd degree HB or with Heart block of any kind. One of my cardiologists said that even if I ended up pacing at 1% it would still be safer to have a pacemaker. Any thoughts on this.....if my numbers go down even further, I'm wondering if I can have it removed Lyme disease or not........Many thanks for reading. I so much appreciate everyone's input. This site has been such a Godsend to me.

3 Comments

Thank you!

by HoneyBadger - 2013-09-21 09:09:02

Many thanks Tracy for your comments and for explaining things so well. Initially I was diagnosed with 3rd degree heart block and that is why pacemaker was put in. The rate response was left on by the rep - which my cardiologist said should not have happened. When it was on, I felt very anxious and not well. I have felt quite a bit better since RR turned off. So now, Dr says I do not have third degree HB, maybe 2nd degree. If I don't pace at all at next visit in two months he said I would wear a monitor for a while to see if the device could be taken out, especially if Lyme test is positive, and I'm treated for it. Personally, I think there is a very small chance that I will have it taken out. I think I have bradycardia that needs treating even if it's occurring 10% of the time- that's still a lot of beats per day. I've only had my lower setting on 40 for one day- it might be psychosomatic, but I feel worse. If this feeling continues, I'll have the dr up the PM back up to 50 or 60 and accept my pacemaker as a permanent fixture. I feel so lucky to have a condition that can be treated. Many thanks again for taking the time to explain things.

pacing

by Tracey_E - 2013-09-21 09:09:28

If you only have heart block, you shouldn't be pacing atrial at all. Did they turn down rate response or turn it off?? Because you probably don't need it.

Does your hr actually go down to 40? And if it does, how do you feel with it at 40?? That's very low. If it leaves you tired and/or unable to exercise, it's kind of crazy to keep it that low simply to pace less. The whole point of having the pm is to get your rate up enough to feel good.

A bit about lower rates. If your hr is going down to 40, then that's where the atrial pacing is coming from. Your own sinus rate is dropping, which is not related to the block. When the heart beats, the atria senses oxygen levels coming from the lungs. The SA node, natures pacemaker, raises/lowers the hr as needed. The SA node tells the AV node in the ventricle to beat, that's where our pulse comes from. With AV block,this signal is blocked all or some of the time.

Lower rate is for atrial pacing. If the atrial rate gets under 40 (or wherever it's set), the pm kicks in with the atrial lead. The ventricles pacing is just playing follow the leader. If the atria beats, the pm is there watching to see if the ventricle beats in sync. It gives the heart a fraction of a second to beat on its own, if it doesn't it kicks in with ventricular pacing. Upper limit is the important number for this, how high will it pace.

Electrical problems just happen. Sometimes infection or medications cause it, but often we never know what cause it. Like that new tv you bought that died when the 20 yr old one in the next room works fine, it just happens. Electronics are like that. Electrical problems are not caused by diet and exercise, how we take care of ourselves. They're unrelated to the structure of the heart or how clear the arteries are. There is some evidence that extreme athletes may be more likely to get them but I wouldn't consider 4 yrs of marathons extreme.

one more thing

by Tracey_E - 2013-09-21 09:09:41

Most of us with av block pace 100% ventricle, none atrial. That's perfectly normal for our condition.

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