First pacemaker check

At this stage it's all about ensuring that it's working well - as in pacing correctly and safely

by crustyg - 2019-12-16 07:34:09

Most of this session is focussed on boring stuff like lead impedances, sensing voltages, capture levels - all the boring electrophysiology that makes sure that the PM is doing its job safely.  Most of us have little real interest in the actual numbers that the EP doc/tech/PA will see on the screen.

However, this *may* be your first opportunity to get them to set your PM to something a little more realistic than the common defaults at implantation, but this may not be important to you, as your profile is quite thin (how you came to need a PM, level of exercise etc.), but that's fine, as some of this is really quite personal.

Commonly the maximum pacing rate will be set to 130bpm which is way too low for an active person of your age, assuming that your heart muscle can take more.  Most of us end up between 150 and 165/170, but it usually takes some negotiation to get there.  And asking for a really high maxHR before your leads have properly anchored in may be too soon - I think I waited about 5 or 6 weeks (went from 50/130 to 50/160 - SSS+brady).

Take a USB memory stick with you, ask to have *ALL* of the PM interrogation data + reports written to the stick which you can take away.  If you never use this, you've lost nothing, and if you start to want to know more about how your PM is working and can be adjusted to give *you* the best possible lifestyle, then it may prove invaluable.

Glad it's going so well for you so far - enjoy the ride!

P.S. - love your handle. :)

PM Check-Up

by TomL56 - 2019-12-16 08:45:54

I've had my PM for three years now and the check-ups are no big deal. One thing that surprised me the first time was that they turn it down for a few seconds. That may not be the right term but it feels like your heart skips a few beats. I was really surprised at this the first time and nearly fell out of the chair. There was a feeling like my heart stopped but it was very quick - was more likely just a slowing down. They really should warn you about that before doing it. I think I made that very clear to the technician.

Now that I know it is coming it isn't a big deal. Good luck. 

First Pacemaker Check

by AgentX86 - 2019-12-16 11:49:47

It's no big deal.  It's probably the easiest checkup you've ever had.  They check the wound to make sure it's healing properly (it had better be at this point) - just a quick look. As others have said, then they "interrogate" the PM to see if your levels of exercise match the settings they've chosen.  The pacemaker keeps a lot of information about its performance since the last interrogation (in your case, implant).  There will be a "histogram" of the pacing rate.  This tells them the percentage of time you spend at the various heart rates.  If you pace higher, they assume you're more active and will adjust the pacemaker accordingly.  Again, as others have said, this is the time to start your negotiations.  It's hard to describe more because we don't have information about your case. But there is reason to understand as much as possible about your pacemaker so that you can negotiate with your EP how to set it up for optimum performance (you'll feel better) and still keep the setting safe for your conditions.  This interrogation/negotiatoion/tuning is a long process, so don't expect miracles right out of the box.  Push yourself to see where the corners are and work with your EP and PM tech on the problem areas.

The part of the interrogation that TomL was describing, where he "almost fell out of the chair" is a test for pacemaker dependency.  Essentially, they quickly run your pacing rate down to 30bpm to see where the heart takes over from the pacemaker.  If your heart doesn''t take over it can feel really weird.  It feels like the Earth just dropped away and you're in free fall (your brain is being starved of oxygen).  The PM tech should warn you before this happens.  The ones I've gone here say something like "this may feel strange" just before the bottom falls out.  I've kinda gotten used to the roller coaster ride.  ;-)

Mine was a little different

by Pacemaker_Sally - 2019-12-16 15:07:52

it also depends on how/why you're being paced. My pacemaker kicks in on demand, which is situationally 4-5 times a day. So if they shut it off, I wouldn't notice unless my AV block was triggered.

If you have a dual lead PM, they will test both leads. For me, the odd feeling was when they paced me (via the right ventricular lead) at 90 bpm while my resting hr was 70 bpm. It felt like my heart was going a bit crazy all by itself. 

the test modes only last a few seconds so the odd feeling is over quickly and they do give you a warning beforehand. 

First checkup

by Dh13 - 2020-01-05 10:52:59

I didn’t feel anything when they checked my PM the first time.   I did have them tweek the upper limit and sensitivity.  They said I might feel something but I didn’t.  But I needed the PM for rate drop when exercising. May not need pacing otherwise