base heart rate increase—side effects

Base heart rate side effects

by Paced2017 - 2018-01-08 19:46:16

I had my first pacemaker implanted 9 months ago for sick sinus syndrome. The base resting heart rate was initially set at 60 both during the day and at night. For the first 2 weeks I was only sleeping 3-4  hours at night and feeling quite hyped up during the day, so my EP lowered the night time rate to 50, which helped my sleep alot. Over time the hyped up feelings settled too.

After 3 days it might be a bit early to say whether your headache is related to the changes made by your EP, but the low grade feeling of anxiety might be. This might settle with time as your body adjusts but if not have a chat to your EP. I  too don't know what the point is of your  resting rate being set at 70 unless you had complained of fatigue or other symptoms at your  follow-up appointment. To my way of thinking unnecessairily high resting pacing will drain the battery faster and mean that a generator change is needed earlier than otherwise.

Good luck and I hope things settle down with time. 

thanks

by heartbeat26 - 2018-01-08 21:35:48

Thank you Paced2017.

I'm grateful for the wisdom of all who are further along on the PM journey than I am. When I had my post-op appointment, the EP and the tech spent a good seven or eight minutes conferring out loud about a case and what the adjustments they wanted to make—only belatedly did I realize they were talking about me. The desired changes to my settings were made without conferring with me or explaining to me any medical objectives/concerns. This may be a widespread problem for PM patients, I don't know: being regarded by harried physicians as merely the housing for an electronic device rather than the sentient being who is obliged to live with the thing—one whose input into the process is critical. You have given me the courage to go back to the EP and ask for a good explanation of the 70 pbm setting and/or request a change!

All best!

resting rate

by Tracey_E - 2018-01-09 10:58:25

If you have heart block, then your resting rate was artificially low when your rate was 40. With heart block, the atria is beating normally and all the pacer does is complete the broken circuit by making sure the ventricles beat every time the atria does. When your pulse was 40, the atria was going faster than that and the heart was out of sync.  In theory now the minimum rate is irrelevant because the pacer is reactive, not setting the pace at rest. I would for sure question 70. There are some reasons for doing that like pacing out of afib, but doesn't sound like you have any of those reasons. 

I would also question if the chronotropic incompetence is because of or in addition to the heart block. CI is when the rate doesn't go up on exertion. If your rate wasn't going up because you are in block, if the sinus rate was going up but the pulse was not, then CI doesn't need to be fixed with the pacer because fixing the block will fix the CI. In fact, the pacer can make it more difficult to work out if rate response (accelerometer) is turned on when you don't actually need it. 

If you have CI in addtion to heart block ( as opposed to because of) and your sinus rate isn't going up on exertion, then the accelerometer will help because it'll step in and raise your rate for you. It's common to take a few tries to get this adjusted properly, to find the balance between going up as needed on exertion and not going up annoyingly when we walk across the room or sneeze. 

It sounds like that doctor may not be a good fit for you. Some are more communicative than others. My cardio and SJM rep have always communicated will with me, letting me participate in decisions about my care and helping me understand changes. Also, I chose a team that is very active themselves so they get the importance of being fit and wanting to feel my best so I can stay active. This is not a priority with all docs.