PVCs and pacemaker interference

Hi All - new here.  I had a Medtronic, 2 lead, rate-responsive pacemaker installed in 2013 due to 3rd degree A-V heart block. The  SA node was failing to send the electrical impulse adequately while exerting myself during exercise.  I was dramatically out of breath very quickly from minimal exertion.  A flight of stairs did me in.  Prior to this I was very active and fit - cycling, ultimate frisbee, etc. The PM solved the problem initially and was able to exercise with pulse getting up to 140. However, over the past year, while still able to ski, bike, etc, I am very out of breath quite quickly if I push it (eg. sustained uphills or getting out of the saddle briefly to crest a hill on a bike.  Forget frisbee.) and my pulse maxes out at 80 bpm.  My cardio blames it on PVCs and says there is nothing to be done about it.  Any thoughts or experience or useful info sources regarding this?  Thanks.  Stefan.

2 Comments

something doesn't add up

by Tracey_E - 2018-04-26 09:55:30

Either the cardio is clueless or you misunderstood. 

PVC's are premature ventricular contractions, little half beats between the full beats. It's true nothing can be done for them but they are harmless. They are little extra beats, have nothing to do with how fast the heart is going.

There's no reason at all your rate shouldn't get up higher than 80. First thing to do is find out why it's not going up. Have you had a stress test or holter? I'd start by requesting those. With untreated av block, the atrial rate goes up but the ventricles don't get the signal. The pacer fixes that by making sure the ventricles beat when the atria does. In theory with av block, our sinus rate is normal.

It sounds like perhaps your sinus rate is no longer normal, which is not uncommon. Chronotropic Incompetence is when the sinus node gets lazy and doesn't go up adequately on exertion. If you have a two lead pacer, it can fix CI with programming. There is a function called rate response that senses movement and raises our rate for us. It's often turned off with av block to save battery because most don't use it, but it's easy enough to turn it back on. It may not work well with cycling because the chest doesn't move enough to set it off, but other activities should be fine with a little fine tuning of the settings. 

I would not accept a max heart rate of 80 without a better reason than pvc's. Ask for some tests to find out why it's no longer going up. You may need to find another doctor, preferably one who's active. Athletic doctors seem to be more responsive to the needs of active patients, in my experience. 

 

You need better answers

by Gotrhythm - 2018-04-27 16:00:17

I never wanted to but I've become something of an expert on PVC's. I've had a lot of them, and while they are normal they can mess with the pacemaker settings.

I too had issues with PVCS and I too was told that because of them, my settings couldn't be changed. Wrong. You can't stop the PVCs with a pacemaker--that's true--but EPs who know their business can still fine tune your pacemaker around them. I took myself off to Duke Hospital and there the EP was able to make the changes to my settings neccessitated by my changing heart condition.

I'm not the athlete Tracey is but I wouldn' accept an upper hr of 80 either. You are  already on notice that you don't have a typical pacing situation. Don't expect an ordinaty, run of the mill cardiologist to know what to do. Even if you have to travel, go to a major medical center where they have experience dealing with the less typical problems.

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