Pacemaker battery due to be replaced

Hi all, I wish I had found this site before now, I have had my pacemaker for 14 years now. I had open heart surgery at 24yo which left me with total heart block.
I have always suffered with ventricular ectopic beats (1000's a day) since i had my surgery, but now I am experiencing much bigger palpitations and I am wondering could the battery be causing this? with it being due for a replacement? These palpitations are so big they make me dizzy and feel so horrible, each time i wait for the huge beat at the end, i worry its not going to come the gap between the horrible feeling and the huge beat at the end is longer, it feels like my heart doesnt beat for that duration.
Has anyone else experienced this? Could it be down to the battery?
Thanks in advance

11 Comments

same symptoms

by Vikisez - 2014-10-28 09:10:20

I don't have a pacemaker yet but a cardio specialist told me today that I probably have heart block from the open heart surgery I had 8 years ago.

I am going to follow your postings on this so maybe I can learn more about my condition. I'm having a procedure done next Wednesday to see if there is damage to the heart.

I'm gonna guess at....

by donr - 2014-10-29 01:10:14

.....what is happening. At least what I will tell you is logical, based on a few assumptions. If they are wrong, this is gibberish.

You have CHB, meaning that your PM runs your Ventricles 100% of the time. (Assumption 1)

Superimpose on that situation Ectopic beats - Premature Ventricular Contractions (PVC's). they are a situation where the Ventricles beat sooner than expected, giving you a wimpy beat that you may not even feel, followed by a heavy one that you REALLY feel. Now your PM cannot solve this problem because it cannot predict when a PVC will occur.

You are used to this feeling because it happens to you a thousand times a day. Actually that's not a real lot 1000/24=roughly 40 per hour, or one every minute & a half.

So - what happens at BATTERY end of life (EOL) You have a Medtronic, so it should drop into its default mode where it just chugs along at a regular pace of about 65 BPM. No sensing, no data storage, just pacing at the default rate. Now this default rate SHOULD be higher than the Ventricular Escape Rhythm for your heart (Assumption 2). If it is, you should not feel MUCH different than you normally feel w/ the PM working full time.

Now, supposing that your Ventricular Escape Rhythm is FASTER than the PM's default rate. That's going to run the horse through a paint booth & it will come out a different color!

A brief aside - what's a Ventricular Escape Rhythm (VER)? It is a rate at which the ventricles will beat absent ANY signals conducted from the Sinus Node that makes the Atria contract. It is the heart's way of having a fallback mode of operating. It is always lower than your intrinsic Sinus Node rate, so that it does not come into play while you have a healthy Sinus Node AND conduction to the ventricles.

So back to the previous paragraph - w/ a VER faster than the PM works, You will get confusion in the ventricles. That will make you feel very cruddy. Further, those ectopics (PVC's) you feel can still occur, since they are generated by whacko timing in the ventricles - at random times, a PVC will be generated. With no atrial signal & no PM signal, the effect is different & much more dramatic. Not only is your heart beating slower than normal, it now has BIG irregularities occurring, leading to the symptoms you are having.

There is a THIRD possibility - your PM NORMALLY will run about 3 months in its EOL Mode. The PM could have totally lost its battery OR the lead to your ventricles could be broken and NO pacing signal exists at all. Now your Ventricles are running completely on their own using the VER as the Heart Rate. Throw in the PVC's & you can really feel bad.

If you would like to read about it, here's an article I found that seems to discuss what you are feeling:

http://circ.ahajournals.org/content/47/4/758.full.pdf

BTW: They call the VER by another name - idioventricular rhythm. This rhythm should keep you going for a long time. it's designed to do just that. Doesn't mean you will feel good, just that you will stay alive.

I do not have your problem, but I have a lot of PVC's & i can recall right after i first felt one I thought my heart had stopped & i was going to die right there in the kitchen.

The way I read this article, the effect of these irregularities on you will be much more dramatic and unsettling - leading to the symptoms you feel.

Well, Susiebear, I'll at least lead off the discussion. Hope you get some better answers from someone else who has been there.

Susie Bear - you are dribbling...

by donr - 2014-10-29 02:10:49

....out the answers slowly. Wonder if waterboarding would have gotten them faster?

DDDR is one key to the puzzle. That says that:
1) First D - BOTH upper & lower chambers are paced on demand based on...
2) .....Second D results from monitoring the activity of the heart and....
3) Third D tells you that both upper & lower chambers are "Inhibited." Meaning that if the PM senses any beating activity in a given chamber, the PM does NOT generate a pacing spike
4) R means that the Rate Response function is turned on to increase the rate at which your heart beats, based on perceived physical activity by a device in the PM called an "Accelerometer," which detects motion due to most exercising.

OK, now that we have the PM's Modes down, it substantiates my assumption that you were paced in DDDR to ensure coordination of the upper & lower chambers. You can live w/o the atria doing anything - they just help fill the Ventricles to make their pumping more efficient & effective. Sort of like a supercharger on an engine in a high powered car.

The fact that they had an external pacer handy at the first replacement tells me that they were worried about the existence of a Ventricular Escape Rhythm. They turned your old one off & your heart continued to beat - at about 40 BPM. That means you do, indeed, have a functioning VER! Congratulations.

Yes, all Medtronics devices do have a capability to do two things as the end nears. First, it will tell the Cardio that it in in an Elective Replacement Period (Or some such nomenclature) that lasts about 3 months. There is NO change in what the PM does at this point, it's just a warning that the Btry is about to croak on you. Second, about 3 months after the Er period starts, the PM, in its daily self checks, will realize that the Btry has reached a point where it will last only about 90 more days & it tells you this by stopping ALL functions except pacing you at the DEFAULT rate of about 65 BPM. The effect is dramatic on how you feel. You feel like CRAP - pure, unadulterated CRAP. But you were expecting it! The PM warned the Cardio when it hit the first milestone.

Your situation is made worse by all the PVC's you are apparently having now that you are in the EOL period.I'd suggest that you get hold of your cardio & have it looked into ASAP, just in case the Btry did croak completely on you.

I just noticed that your Lower Rate is set at 60 BPM. Perhaps your default rate is 55? Maters not - CHECK your pulse accurately & find out if it's near 60 or above. Above 60, PM still functioning. Below. get in for a checkup.

Donr

reply

by susiebear - 2014-10-29 06:10:08

Thanks donr for taking the time to reply with such explanations. Its a terrible feeling when you have to wait for that beat, wondering and worrying it isnt going to come, i know it very well.
I have a pm check due in december, i think i will try bring it forward to make sure all is working as it should. I know i am very sensitive to any feeling inside me. Thanks for the link, i will check that out now.

Vikisez feel free to ask anything you wish, if you have heart block without a pacemaker, what does your heart rate sit at? i know when mine is turned off it beats around 40 but doesnt beat properly, the top and bottom parts of the heart just beat as they wish to, they dont follow a pattern. I only had it turned off once when i was having my previous battery replaced 7 years ago.

Thanks again for the replies :-)

You answered one question...

by donr - 2014-10-29 10:10:06

...when you told me your intrinsic rate for the Ventricles Escape Rhythm - 40 BPM. If your Medtronic PM is like all the rest of them - mine included - it has a default rate of 65 BPM. When this happens during EOL, it does not sense, it just paces - at least that is my understanding. Tracey E, who is also a CHB patient, may say otherwise from being an actual hostess of a PM for CHB and having experienced EOL more than several times. Your battery life fits 100% ventricle pacing - about 7 yrs.

If you have a fully functional SA Node, but just a CHB, you do have P waves, they just don't go anywhere to influence the Ventricles. In reality, your top & bottom just beat at two different rates - both pretty steady, but totally out of synchronism. Your SA probably runs at about 60 BPM or higher & your Ventricles at the stated 40 BPM. It is very difficult to sense atrial contractions, but they still do occur & do not help the ventricles very much at all because they don't beat in sync. I just went to the Medtronic site & read that you are most probably paced in DDDR mode to get the Atria & Ventricles in sync for efficient pumping. That would reduce the PVC's to a mild nuisance (Relative to your current situation).

If you now pile on the PVC's w/o any pacing help, your ventricular rate becomes very erratic, causing the symptoms you feel & are described in the link I sent you.

Donr

more info

by susiebear - 2014-10-29 11:10:11

Yes i recall the letters DDDR listed on my pacemaker card i was given with my first implant. I don't know what all these things mean though. My PM has a minimum of 60bpm and max 180bpm. Originally was set to 120 then onto 140 max but it wasn't enough for me to get up a flight of stairs so at 180 that is ok.
I was told my heart probably wouldnt beat without the pacemaker so with an external one to hand at the time of my battery replacement 7 years ago, they turned it off and it did beat alone and they told me it was approx 40bpm and worked well enough to go ahead with the replacement without the need for external pm.
I do hope this is the same again this time around, as I read your heart can get lazy when being paced for many years and may not do so in time.
I assumed they would replace my battery with enough life in it to work properley right up to replacing, is this not the case? with you saying it has a default setting for EOL?
Many thanks you have been a fantastic help!!!

im sorry

by susiebear - 2014-10-30 08:10:18

I don't know much about my pacemaker, i always thought I knew enough until i have read your messages, now I realise i know nothing!
I do know that 2 years ago my rate response was turned off by the pm tech's. He said i didnt need it and it was making my heart race for no reason (which is true). I can't walk with an umbrella up in my left hand, or clap my hands without it racing, i gotten used to that but then it was turned off.
The only set back this caused was head rushes when i get up from sitting down. I put up with this because its better than my pm racing for no reason.
My pulse at present is 76 so i know my pm is working, good idea what you suggested thanks.
When i go in for my next check i will ask some questions.
Thanks for your help you have been amazing, taught me so much!
Are you a doctor or pm tech?

Another dribble of info....

by donr - 2014-10-30 10:10:15

.....Thanks. This one is important because it tells me that Your SA Node is properly working & tracking your body's need for increased HR with exertion. Remember the "R" in DDDR? That told me that your PM's Rate Response function was turned ON, implying that your SA Node did NOT respond to your body's call for faster HR. FYI, that kind of condition is called "Chronotropic Incompetence."

But for the flock of PVC's you have, your PM working in DDD mode, with a SA node reacting to increased rate needs, should have fixed you up quite nicely w/ nothing more than a 3rd Degree block (The word "Nothing" does not make light of your condition.)

I can easily believe all the misery the R function being turned on could cause you. None of the PM mfgrs have come up w/ a perfect R function. The human body has an extremely remarkable sensing-adapting capability to determine exactly (Most of the time) what kind of HR you need. Those needs are transmitted to the SA node, which sends the appropriate HR signals to the heart.

Engineers have been able to create computers that can fly a complex airplane better than a human can; build a computer that can take a tall, skinny rocket and keep it stable enough to get to a spot in space with a precision that is unbelievable. Go pick up your broom and balance it upright, weeping end up, on the palm of your hand for over 8 minutes w/o it falling over. Also, built a system that took a Rover device from the Earth to Mars & successfully landed it such that it can crawl around on the surface. BUT - man has yet to be able to sense needs & generate a response to the human body's need for increased HR! Your brain & whatever sensors it uses, can however! That's why the R function being turned on did such weird things to you like when you did something as simple as holding an umbrella up.

I am neither a Dr. nor a PM tech. I am an electrical Engineer - very dangerous people, us engineers. I have a PM for essentially Bradycardia, but my SA node is chronotropically incompetent - at least to the point where I have my R function turned on & I have no weird experiences w/ it. I also suffer several thousand PVC's per day w/o sensing them - as long as they don't come in long runs. As I told you right up front, I guess a lot; use Google a lot & try to reason to logical conclusions - to create answers that fit the symptoms reported. If nothing else, I can at least stimulate questions in your mind that will make sense to a LISTENING Dr. when you ask them.

For instance - based on our exchange, you now know that your PM is still functioning, based on a simple test you were able to perform - taking your pulse. If I guessed wrong, at least I have given you confidence that things are not falling apart & failing on you & that there are rational reasons for your situation & the way that you feel.

Hope I have helped. Pls go read my Bio-sketch for more of my background.

Donr

Sue: I cannot...

by donr - 2014-10-31 08:10:32

...answer your question. You live in the UK. I am in the US. Our systems are too different for me to give you the answer.

My Cardio is NOT an EP; but he is very savvy about PM's. He has an EP associated with him in his clinic. I will defer to Ian & Tat Man on this one.

He has always been able to answer any question I have asked, so I have not had problems like you are having.

Donr

thank you donr

by susiebear - 2014-10-31 08:10:55

You have been an amazing help, you have taught me more than any of my drs, cardiologists and techs. Tell me is it normal to never see a pm specialist regarding the pacemaker? I have a cardiologist for my heart issues, a doctor for general issues but i have never seen a specialist re my pm. This is probably why I know nothing! I wonder if this is normal?
I will go read your bio sketch now, i assume i just click on your name for this?
Thanks again
Sue

Medtronic battery

by NormaLou - 2014-11-07 01:11:45

Susiebear,

My Medtronic PM battery died after three years. Just a few months before, they told me there was 7 yrs. left on the battery. It was a defect. They called it "end of life" (EOL) during which time the PM doesn't pace, but as donr said, it holds your HR at about 65 beats regardless of what you are doing - exercising or watching TV. I had all kinds of weird symptoms and felt my heart beating in all places in my body and came very close to fainting several times after eating a meal. It definitely wasn't fun.

I hope you can get your issues resolved soon.

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