Rate response

pacing

by Tracey_E - 2018-06-13 11:11:27

With av block, in theory our sinus node works normally so we don't need rate response. The atria goes up and down as it's supposed to but the signal doesn't get to the ventricles. The pacemaker is completing the broken circuit, making sure the ventricles beat when the atria does, essentially playing follow the leader. If the atrial rate dips lower than 60 it will pace atrial but that doesn't happen often for most of us with av block. If your rate never goes higher than 60, then you've got something more than just av block going on and you'd probably benefit from having rate response turned on. Go talk to them. 

Pacing

by Vince - 2018-06-13 12:42:44

Hello Tracey.

Thank you for your response.

As I said I have an intermittent 3rd degree electrical heart block.

I am okay when my heart is functioning on its own. But when the 3rd degree block happens and I am paced is when I am having alot of issues.

I get out of breath on exertion, even just talking. Start sweating, problems concentrating. Feeling overall just terrible.

Then I measure my hb at about 61bpm. That is how I know it happens when I am being paced. I have to go sit down and stay still to feel a little bettter.

When my own hb kicks back in over 70 or 80 and I am doing things then I feel fine.

Vince.

pacing av block

by Tracey_E - 2018-06-13 13:23:01

You shouldn't even notice episodes of av block when paced because the pacer steps in any time the signal is blocked and does what the heart should have done on its own. It's seamless. The atria beats, the pacer gives the ventricles a fraction of a second to beat on their own, if they don't it sends a signal that makes the heart beat so the heart always stays in sync.  I'm no doctor but what you are describing sounds more like sick sinus than av block. That's when the sinus node gets lazy and either slacks off when we are at rest or doesn't go up as it should when we exert. Sometimes it slows down then when we get up and move it kicks in and beats normally. That's all atria/sinus node. 

SJM/Abbot has an excellent animation that shows both av block and sss and how the pacer fixes both, https://www.sjm.com/en/patients/arrhythmias/symptoms-causes-diagnosis/bradycardia-slow-heartbeat

Go talk to your doctor. They can tell by the interrogation report how much the atrial lead paces, how much the ventricular lead paces, how often you are at 60. If the only thing you have going on is av block, it will be 0% atrial, up to 100% ventricular. Most of us with 3rd degree block pace every beat but if yours is intermittent then it will be less than that.

The atrial number is what's going to be interesting. If it's not 0, then you have more going on than av block. Write down the times when you feel bad, they can see what the pacer was doing at that time. It should be a simple fix to adjust the settings. If that doesn't get it, another thing they can do is put you on a treadmill and watch what the heart does on exertion. I have a whole mixed bag of problems in addition to av block, this is what it took to get me all fixed up.

What does it mean?

by Gotrhythm - 2018-06-13 13:52:41

I can't claim Tracy's expertise on the subject of heart block.

However, I think you might be making a logical error. You seem to believe that the pacemaker is causing your symptoms. But it seems more likely to me that what is happening is that whatever the pacemaker is doing is failing to alleviate certain symptoms.

You could be having the problem because (1) the pacemaker settings aren't correct for you. For instance, if RR isn't turned on, then the pacemaker can't raise your heart rate above 60 even if you need a higher rate because you're working out. The pacemaker can only do what it's programmed to do.

or because (2)  you have some other rhythm issue in addition to the heart block that the pacemaker hasn't been programmed to deal with.

In either case the answer is to return so that things can get checked out. Feeling like you're going to pass out isn't good. You shouldn't put up with it.

Let us look at the facts

by IAN MC - 2018-06-13 16:29:46

Everything I have read suggests that MOST people with AV block need Rate Response switching on . ... if not initially, certainly after a few years.

The mechanism is irrelevant , whether it is something else going on or not doesn't matter .

There are many explanations but If you get breathless when you try to exercise then you possibly need RR  switching on ;  so try it, and see how you feel !   

Ian

Similar situation

by sarahm - 2018-06-14 21:12:45

Hi Vince,

Your story sounds a lot like mine! 3rd degree heart block, bradycardia & implanted last August. I had a fair bit of trouble with exercising and it took quite a lot of tweaking. I ended up calling my pacemaker clinic (where I go for my check ups) and they called me in for a stress test. It took about two hours but they switched a setting off (one they don't normally tweak) and I've been able to run comfortable again since. All of my readings since have been normal.

I don't know how old you are but I'm only 22 which has thrown the technicians a little bit as they aren't as familiar with treating this specific set of issues in someone active. Well, it's thrown my technicians at least.

Good luck! I am sure there is a solution out there, even if it might take a little bit of experimentation to sort it out for you.