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Monitoring

by H van Dyk - 2023-07-02 06:01:56

Monitoring via the old-fashioned way (finger on the wrist) is best. I've read stories and negative remarks concerning these 'monitoring' applications.

Search engine

by Penguin - 2023-07-02 06:16:26

I too have heard mixed reviews of how Apple watches and other devices pick up heart rates. 

If you go to the search icon at the top of this page and put in 'apple watch' you will find a selection of old posts which may help you. Some people suggest that h/rate is lowered by ectopic beats and others doubt the accuracy of the device. As H van Dyk says 'finger on the wrist' may be the most accurate measure. 

On the positive side you say that you feel good / well despite these readings.  That's good!

You also suggest that you are still in recovery from your implant. Therefore it's worth considering the effect of an operation and anaesthesia on your heart rhythm as some people state that the interference can affect arrhythmia / irregular heart rhythms and electrical conduction afterwards for an amount of time.  It should settle down if this is the case. Maybe keep your finger on the pulse for a few weeks and see if things improve, but if you feel unwell or have a return of your original symptoms contact your pacing clinic. 

Best Wishes

odd HR patterns

by Ahilltopper - 2023-07-02 10:25:02

The HR patterns you describe are odd.

Firstly read up to make sure you are using the Apple watch properly. https://support.apple.com/en-us/HT207941
It won't work as a HR monitor unless you wear the watch snugly on the top of your wrist. If the watch moves when you rotate your wrist rapidly back and forth it is too loose to give accurate readings.  I bought an Apple Watch 6 after my PM implant two years ago and have found it to work very well for monitoring my HR during my activities which include running, walking, Nordic skiing, downhill skiing, bicycling, tennis, kayaking and pickleball; as well as at rest. It is certainly as good as the finger clamp monitors my GP's office uses.
If the weird pattern is not due to how loose your watch strap was, then I would notify your clinic and EP right away, because it could be a PM issue.

Fitbit Versa 2 accuracy👍👍

by zawodniak2 - 2023-07-02 11:58:53

My fitbit virtually never shows my heart rate under 60 bpm.   
just saying-go figure!!!

On my second Medtronic and due for my third in a few more months

Gid willing and if the creek don't rise

              Rodger

Heart rate

by AgentX86 - 2023-07-03 00:30:13

Because one person doesn't see the heart rate fall below the minimum doesn't mean another doesn't.  We're all different and these things work better for some than others.  If an arrhythmia is present (particularly an irregular arrhythmia) they don't do well at all.  The Pulse-Ox style are particularly poor.

The wrist isn't the best place to monitor pulse.  The radial artery isn't very large and may hide arrhythmias.  A PVC, for instance, will keep the blood from completely filling the heart, so the beat will be weak.  A watch, Pulse-Ox meter, pressure cuff, or your finger may miss this weak pulse.  It doesn't pump much blood but it counts as far as the pacemaker is concerned.

To feel this inefficient pulse a larger artery is often needed, like the carotid (neck) or femoral (groin) arteries. Of course, some of us can (unfortunately) feel each one.

Thanks everyone!

by Mojojojo - 2023-07-03 00:45:08

I am still very new to this so probably will discuss this with my doc in few days in my 1 week post surgery appointment. 
 

Nothing irregular has happened since the yesterday's event and I am thinking it is just my apple watch playing games with me. I was constantly over 60bpm whole night after that episode which could not have happened without PM doing its job. 
 

I'll update again here post my appointment. 

Heart rate

by piglet22 - 2023-07-03 06:10:30

" I was assuming that the pacemaker will never let my HR go below 60 but it seems like it is allowing it go as low as mid 40s and then firing up? Is this normal or my PM is malfunctioning?"

Don't assume that.

There are differing views on how and where your heart rate/pulse should be measured.

I can't speak for Fitbits or similar devices as I don't have one, but there is the old expression of Jack of all trades etc.

In my reasonably long experience, oximeters do not give accurate pulse rates. I use the same model as the GP uses, but there's something possibly in it's software that makes it stick on a reading after a while, almost as though it's doing very long averaging.

A decent blood pressure monitor seems to work well.

I've never had success with finding pulses at any site other than the radial pulse, and for a quick indication, wrist is my go to.

I'm in the middle of an ectopics meltdown. I get erratic and low pulse rates however it's measured.

For years my pacemackers (Medtronic dual lead) were set to 60 bpm.

Ectopics stepped in 6-months ago and was dropping my pulse into the low 40s and mid 30s.

It was making me unwell with dizziness, a blackout and numerous falls. Even this morning, I woke up to a slow pulse, erratic with pauses. My normal blood pressure of 130/70 was down to 100/50. Pulse was better than other occasions being in the 50s bpm

Whichever way you look at it, the pacemaker is not maintaining 70 bpm.

I'm struggling to get this looked at. The GP understandably can only do so much. Cardiology has been aware of this since January 2023. I had one visit to the clinic to get the bpm raised from 60 to 70, but the crucial bit is that the consultants who are supposed to look after you have kept quiet throughout.

The pacing consultant so far has told the GP it's ectopy and changed my medication from 50-mg Atenolol to 1.25-mg Bisoprolol. After a bout of tachycardia, that was raised to 5-mg.

I'm down to have an "urgent" PM interrogation at the hospital. That is assuming the doctors, radiologists and consulatants aren't on strike and the postman manages to deliver the letter.

Such is the state of UK 2023.

Maintaining rate

by AgentX86 - 2023-07-03 10:55:37

You pacemaker indeed is maintaining rate.  If you're reading your pulse via the radial artery, you can easily miss the (beat after, I've just discovered) ectopic. The carotid beat should be very easy to find because they're very large arteries and close to the heart.  The double beat of the ectopic can be felt there.

Pacemakers work by setting a timer (to 1/rate) after a sensed or paced beat.  The timer counts down milliseconds and if a beat isn't sensed, it supplies a pacing beat and resets the timer.  There is always a beat, either natural or paced at a minimum of the timer setting.

However, an ectopic can insert a beat too quickly after another beat.  Remember, a timer is set after any beat, so it is reset on the ectopic.  This fast beat doesn't allow the heart to completely refill so the next beat pumps less blood and is weaker.  This is the pulse that's often missed in the radial artery.  So, the counted rate is not the pacemaker rate but the inverse of the time from a normal beat plus the time of the ectopic. The pulse-ox style of monitor is then fooled by this "longer beat". If the extra beat is counted (in the carotid or by an EKG style monitor) it is averaged into the rate so it comes out a little fast (the shorter ectopic is counted as a beat but is shorter/faster). If the rate is counted fast, we ignore the reading because we expect that it can be fast for a number of reasons.  We never expect it to be slow because the pacemaker won't allow it.

This can easily be seen on a Kardia Mobile EKG device.  For $70 ($110 for the six-lead), it may be a worthwhile investment. There is a lot of information in there and, depending on your cardiologist, you can send the EKG trace to your cardiologist.  You can also send it to one of their cardiologists for an interpretation.  This is quite expensive ($69, IIRC) so probably not worth it.