Pacer cutting out due to body temp???

I have a Medtronics Revo SureScan Pacemaker, implanted due to complete heart block back in Feb. For the most part all is good, with a couple of issues. Mainly it is that sometimes my pacer quits pacing...then proceeds to kick back in after I stop what I am doing and rest a minute. My settings were changed a couple months ago to 60 -150, and the delay was shortened. This improved my ability to swim laps. I am not a fast swimmer, but I need to get in the pool 3 x a week to keep my joints going (59 and arthritis). I usually do laps for about an hour.

I had one instance when walking uphill to my car in Durango, CO (7900 ft elev) when the pacer cut out. It was a warm day. I have had repeated instances of this happening after taking a hot shower, and also if I try to use the Jacuzzi at the gym. Kind of takes the fun out of relaxing after a workout.The strange thing is that when it happens, I stop and take my pulse. When the pacer kicks back in my heart rate is usually only about 125 or so, which is nowhere near my 150 max. Any ideas as to what could be causing this?

5 Comments

Hopeful

by Dee224 - 2014-09-11 09:09:13

I just got back from seeing the technician and apparently I was still going into "Pacer Block" whenever my heart rate went over 130, even though my setting were 60-150. So, she was told by Medtronic tech support to turn on a setting called "rate adaptive" and set that to go up to 140. I am heading to the pool tomorrow, so it will be interesting to see if it makes a difference both swimming and showering after!

Safety...

by PacerRep - 2014-09-11 11:09:42

I've heard sporadic tales of this in my line of work and I do not question your symptoms. So what I've done in the past when patients tell me about becoming faint in the shower...especially with 3rd degree block like you have, Is I set the pacemaker as safe as possible. So what does this mean.

1). Increase the output safety margin. Industry standard is 2:1, Request that they set you 3:1. I am extremely doubtful that this is the cause...but again, safety.

2). This setting is more likely to help. Since your pacing 100% of the time anyways in the ventricle, who cares anymore about sensing intrinsic ventricular events. Set your ventricular sensing as low as possible, filter out any and all noise. Heat could be causing your muscles to conduct myopotential differently and allowing your pacemaker to "inhibit" pacing. Tell the tech to set your ventricular sensitivity to 15mV.

I have not had a patient tell me they still feel these symptoms when making these changes, however I honestly can't give you a really good answer on why this happens.

Good luck

Thank you!

by Dee224 - 2014-09-11 12:09:52

Thank you! I will discuss these options with the tech!

Ahh pacemaker wenckebach

by PacerRep - 2014-09-23 01:09:02

Yeah medtronic's are bad about that. But I'd be surprised if this was the problem in a shower.

Better

by Dee224 - 2014-09-25 12:09:41

Since the adjustment I have not had an episode of my pacer cutting out. I have been able to get my heart rate up in the pool (just over 130) and have not had any episodes of dizziness after hot showers. I am not ready to say that this is the perfect solution yet, as I have not tried a Jacuzzi yet ;-) but it is definitely an improvement!

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