Pacemaker side affects

thoughts

by Tracey_E - 2019-07-25 08:55:43

Do you have a pacer or ICD? Big difference. If they gave you an ICD it's because they think you are at risk of potentially life-threatening arrhythmias. Pacers make the heart go faster. 

Are you pacing? If you are, then odds are pretty good you need it. You can ask questions about how you pace. If you pace atrial, that indicates SSS, your heart got too slow. If you pace ventricle, that is av block, because the atria beat but the ventricles didn't keep up. Those are two separate conditions, tho it's possible to have both. They don't just randomly put pacers in when they do ablations, those are two separate surgeries, and they don't do ablations unless something else is going on. It sounds like there is more going on than what you've described. 

PMT (pacemaker mediated tachycardia) is  what you are asking about. Pacers are a gas pedal, not a brake. If the heart takes off on its own, the pacer is just going to watch. If it goes too fast, it can trigger the ICD to fire. That's what it's there for, to reset us when the heart takes off dangerously fast. Ask your doctor, how fast was the VT and how long did it last? And were you pacing at the time? I'm no expert but it doesn't sound like PMT to me, that would be an ongoing problem not a single episode. 

The ER giving a clean bill of health is not at all the same as your cardiologist/ep saying everything is ok, especially if they didn't even interrogate the device. That just means at the time they had you on their machines, everything looked ok. They treat emergencies and release, they don't dig deeper. It doesn't mean nothing happened or there isn't something else going on. That's why they always say follow up with your doctor.

last thing

by Tracey_E - 2019-07-25 08:57:16

Most of us are otherwise healthy. Electrical problems are totally different than structural problems or clogged arteries, and most of us never know why it happend to us. It's a short circuit. 

Side Affects

by Keithwhelpley - 2019-07-25 11:32:53

Thank you Tracey. I follow your comments and love what you have to offer. I didn’t want to get into the weeds on my real concerns in this first post. But like the pro you are, you sniffed out some holes in my story and asked very good questions. 

I’ve told my story in this forum before. But because everyone thought I should face my new reality and doctors didn’t seem interested in my concerns, I tried to just live with this. I do have an ICD along with the pacemaker. It was the ICD that paced me out of these recent VTs Thankful it was there. But the need for my pacemaker is in question. I was given the pacemaker after my heart, for the first time ever, went through severe erraticness. They diagnosed Sic Sinus Syndrome. When I experience a VT after implantation they decided I needed an ICD instead. I was sent to the EP for a heart study, an ablation if needed and an ICD. When I got out,  I had a unit that was a pacemaker and ICD — very common, as you know. 

I began to question the PM’s need when the EP said I didn’t have SSS or heart block. He said he left me with a PM unit because my original doc (a cardiologist and not an EP) had put one in. He wasn’t going to question that despite the new evidence. I further questioned the need when I was able to stop taking metoprolol, which was a key part of the strategy for keeping my heart rate in control. The beta blocker would keep my heart from racing and the PM would keep the Metoprolol from driving my rate too low. So why the pacemaker, now?

My new cardiologist appears to want to come to a diagnosis. She scheduled me for a treadmill test to see how my native heart rate responds to exercise. My device check shows I’m being paced at 70 percent in the atria, which is predictable because my native rate has always been low (48-50) and my PM is set for 60. The interrogation showed my native resting rate wants to be 48-50bpm. 

Up until my last check, my ventricle pace rate was 4-7 percent. Last check it was 14 percent. This may be reflective of these VTs, which originate in the ventricle. The bright spot is that my native heart rate, except for these recent events is even and smooth. 

My new cardiologist wants to determine if there is some other “incompetence” besides the now debunked diagnoses. I like where it may be going. I’m willing to live with a PM, just tell me why I have it, if you can.  

My position is that I don’t want to do anything invasive again until we have an accurate diagnosis for the PM.  Otherwise we are layering treatments atop a faulty foundation. There is enough written about what pacemakers can induce that doesn’t allow me to let go of this. 

We all should know there is a percentage of people who receive PMs who didn’t need them through honest mistakes and misdiagnosis. It’s right to question until you have answers 

You need answers

by Gotrhythm - 2019-07-25 17:23:51

I have a lot of sympathy for someone with a complex, unusual arrythmia. I had PVC induced PMT. In my case there's no question I need a pacemaker but I have to have some fairly unusual settings to make it work for me. And even to this day, my EP is alert for any signs of VT.

I think to ask, Exactly what good is my pacemaker doing for me? is rational, especially since your heart appears to be able to maintain a resting rate of 48-50. It's good to know your doctor is also checking your heart's ability to speed up when needed. Just because you don't have one rythm problem doesn't mean you don't have any.

Given that the pacemaker has caused a problem for you, you know you're not worrying about "nothing." Questioning everything, and not giving up until you have reasonable answers makes perfect sense to me.

Stick to you guns.

Thoughts

by Keithwhelpley - 2019-07-26 02:03:16

Tracey, I think you may have answered my question. I read more about PMT and it feels like exactly what I’m going through. It’s described as an anomalous endless electronic loop created between the atria and ventricle. As I understand, the rate of the tachycardia will be determined the high setting on the pacemaker. But why are these episodes starting now, I wonder. What changed in the past week? I hate the feeling but this all is fascinating. 

My daughter is in college for genetics and is interested in med school or maybe medical device development. I told her to design a wiring harness that goes inside the heart chambers and creates safe pathways and transfer points for people like me. 

Ventricular Tachycardia

by Selwyn - 2019-07-26 07:46:53

The question is not how common are PM induced ventricular tachycardias, but rather what is the origin ( aetiology) of YOUR tachycardias?

If as I suspect, you had the ventricular  tachycardia prior to your ICD/pacemaker, with a failure to maintain your circulation ( blackout/faint)  then clearly your ICD/pacemaker may be life saving. Was it the chicken or the egg that came first?

The diagnosis of pacemaker induced tachycardia is something a qualified pacemaker technician is trained to detect, whether sensor driven, endless loops, re-enterant, or muscle related.

 Most ICDs come with a pacemaker function built in. Depending on the cause of your tachycardias it is possible for the PM circuit to respond ( and out-pace the tachycardia)  before your ICD 'fires', thus saving you the trauma of a shock. 

Further info @ https://www.medscape.com/viewarticle/490543

Chicken or Egg

by Keithwhelpley - 2019-07-26 11:01:59

Selwyn, you are so accurate with “chicken  or egg” analogy especially since so little is studied about real effects of implanting devices and leads into the sides of our hearts. 

I did experience VT about 18 months ago. that caused me to pass out and crash my bicycle and subsequently receive a pacemaker/ICD. It was the first time I had experienced such a thing. 

Fast forward to these very recent repeated SVT and VT events, I have to wonder if this is just where my heart is at 58 years old or the result of the implants. I certainly am greatful that my ICD or pacemaker was in place to stop the SVT/VT, but it would be irresponsible to myself to NOT read literature and wonder if these new events can be attributed to this new device. Has “Hal” taken over the ship. It’s disturbing to know that a “endless loop” can be created by a device without any organic input. Is a dual chamber pacemaker/ICD a self-fulfilling prophecy in the case of my PMT, if that is what I’m experiencing. I have no idea, yet. But the best source of best information comes from communication between people who are living with these devices and reading  scholarly articles, albeit slightly exotic and obscure. I have learned more from reading these articles and anecdotal experiences on forums like this than I have from technicians and doctors who only seem to answer those questions that are framed just right. The flaws in the doc/tech-PM patient relationship comes from WE not knowing what there is to know. And docs and techs not knowing what we are sensing in our chests as PM/ICD recipients 

Pacemaker mediated Tachycardia

by Keithwhelpley - 2019-07-30 15:08:16

I have an update on my condition I posted about last week. After a week of multiple VTs that had never happened before in the 15 months of Pacemaker/ICD implantation, I finally saw the St. Jude's tech. While he coulnd't advise me, he did confirm that there seemed to be an electrical loop created in my system, but he didn't want to say any more except that it was lucky I had an ICD, which paced me (not shock) out of danger. And it did. He made a slight adjustment, (Don't tell me what, I can never understand the jargon).

I saw my general cardiologist Monday. And she has no more answers, but was aware of my fears of a Pacemaker Mediated Tachycardis. True to good doctoring, she wanted to check off every box and set me up for tests.  The question: Why was this healthy 58-year-old man suddenly haveing tachycardias only 15 months after PM implant. 

I have argued since I received the PM (not the ICD) that they may have jumped the gun even if PMs and ICDs were the same unit nowadays. I've told every doctor reasons I felt that way, not the least of which was that every condition diagnosed for the PM later turned out not to be accurate by a heart study.  Regardless, I was met with scepticism, questions and ultimate disbelief. I've left three docors. The facts for me were that my PM never felt right. The quality of life promised has never materialized. I have been forever tentative because it felt like all hell could break loose at any moment because of the bouncing ping-pong ball inside my chest -- no matter what adjustments. And every interrogation showed my device was performing as designed. All I said was that I was glad the divice was working great, but what about my heart. One tech told me that there is "no doctor who will remove that pm regardless of what you think it's doing to you."

I've posted on this forum and received similar reactions to my story. It was becasue of THOSE reactions that I simply sat back and tried to accept my new reality. And when I began going into VT last week, my first thought was: Maybe everyone was right. Maybe I need this PM. Time to just shut up.

But then came a post from Tracey_E (above) she brought into focus the concept of Pacemaker Mediated Tachycardia. I had heard the phrase, but never researched. I was on it. It became my pork chop.  All weekend long, I chewed on it. I brought all my information to my cardiologist. She patiently listened and actually read the articles I had found on medical sites. She told my why some didn't apply to me. But she was respectful of the possibility pacemakers could create NEW electrical problems. 

Earlier in my journey my pork chop was "Pacemaker Syndrome," which creates heart failure symptoms in patients. Over the past year, I have had to fight doctors who started categorizing my condition as heart failure, hanging it on the tiniest of symptoms that had never been there before, as though heart failure can pop up suddenly, without any underlying sickness or event -- to my vocal insistence that "I don't have heart failure."

But Monday I detected a glimmer of hope in my new young general cardiologist. She listened. She didn't dive into my crazy (still think I'm on to something)  theories, but listened. She read the things I brought to her. When she could, she told my why a case didn't apply to me. She then said that I didn't have heart failure. Take that off the table. And then she said something that no other doctor has said since my implantation. "I like the way your (intrinsic) heart is functioning." My jaw dropped. "You do," I said. "I do." she said. We need a stress test to see how it responds to demand.

Before anything is turned off or reprogramed, she is sending me in for every plumbing test there is to make sure there isn't underlying contition that could create an "intermitent incompetence" for these recurring VTs. Then over the the EP to determine where these new electrical issues could be coming from.

This time next year, chances are, I still will have the functioning pacemaker in my chest. But this young doctor isn't taking it for granted. There is NO diagnosis supporting the PM. She wants to know why I need it.

THANK GOD! so do I.