My PM and Ectopic Beats

Hi Pacemaker Experts

Going to start off with my question: CAN A PACEMAKER IN ITSELF CAUSE ECTOPIC BEATS?

Since I had my Medtronic Dual Chamber PM fitted on 4th Feb for second degree AV block I've had strange beats/thumps in my chest and throat. These have now been diagnosed as ectopic beats and they have been trying different PM settings to stop it happening.

I was only being paced less than 4% of the time in AAI<=>DDD Mode set at 60ppm and gettting thousands of the extra beats day and night. So they decided to set it at 80ppm which was then pacing me 100% of the time in the atrium - hoping that this would stop the ectopics with the PM taking over
from my heart. Tried it for 10 days but it didn't work and it also made me feel out of breath and a bit fuzzy in the head. I was also a bit unhappy at being paced 100% in the atrium when my heart was managing for more than 96% of the time by itself.

Now I have been set to VVI Mode at 40ppm. I am still getting the ectopics - maybe slightly less. Am I right in thinking that this setting means the pacemaker isn't doing anything unless my heart drops below 40 in the ventricle? Hope this is ok? This is my new doctor who is an EP who is making these changes. At least he is trying to help. My old cardiologist really wasn't interested and wrote to me saying "... it isn't pacemaker malfunction in any way at all". I never thought it was - just wanted them to tweak the settings to try and solve the problem.

These ectopic beats were hardly recorded on the 24 hr ECG prior to the PM being implanted but there are thousands and thousands now and I am afraid they are unable to answer the question as to why I am having them. They are talking about possible ablations and beta blockers and I am now getting very worried.

Compared with some of the awful problems some of you are having this seems fairly trivial but I now seem to have problems that were not there before the PM implant. Any help would be much appreciated.

Thanks for listening.

Sue from London

4 Comments

ECTOPIC BEATS

by SMITTY - 2008-05-10 11:05:27

Hello Sue,

The simple answer is yes a pacemaker can cause ectopic beats. An answer of why it is happening to a particular individual is difficult and beyond my ability to provide.

I went through a period of these extra beats for awhile and it turns out that all that was needed was fine tuning of my pacemaker. However getting that fine tuning was not all that easy. It takes a doctor with superior knowledge of pacemakers that also is interested in solving the problem. All I can suggest is complain and complain until you get the care you need.

In my case my PM was given a low setting of 30 for a few days. I could do this because I am not PM dependant. In fact when the low set point was 60 my PM assisted my heart beat less than 5% of the time. With the low set point at 30 my heart rate never dropped below 50 ao the PM was just along for the ride. When my PM was, for all practical purposes, turned off the extra beats went away. Then the process of fine tuning my PM started and this took 4 0r 5 tries, but the problem was solved.

I wish you the best,

Smitty

pacemaker induced pvc

by luckyloo - 2008-05-11 04:05:36

my pacemaker did that too. i believe the AV delay was too short so if i had a PVC the pacemaker didn't wait long enough for my own heart to beat again. it was driving me nuts! my pacemaker is now down to 30....it will only beat for me if i drop below 30. the rate smoothing function was rurned off too. when this was all happening, my pacing went from 1% in both chambers to 18%. now i pace 0 % and i don't have those PVC's. i believe your EP can tell if the PVCs are pacemaker generated by the info on the interrogation.

luckyloo

Ectopics

by Carol - 2008-05-11 12:05:08

Hi Sue,
I had my PM placed in October 2007 and I went through a period of time that ectopics seemed to occur at an increased rate. I felt pretty bad for a few months until they finally adjusted my settings correctly. In fact, it took a consultation with the Medtronic Rep before all calmed down. I still get skipped beats now and then and have had a few "runs" of 4-5 beats, but overall I'm feeling like my old self again as before PM. However, I do take Beta Blockers and have for over 20 years...I seem to tolerate the drug very well unlike some of our other fellow pacers (Smitty- thinking of you in particular!). My low setting is set at 50...I too have a 2nd degree AV block and am not 100% dependent. My PM merely senses my atrium and then assists the ventricle as needed.
I agree with Smitty....keep at them until you are feeling well....I did....even though I believe I was being "labeled a neurotic". I knew it wasn't all in my head and the proof was there when the Rep's suggestions cured my problem. Hope this helps and that you're feeling better soon.
Carol

Another possibility

by ElectricFrank - 2008-05-11 12:05:46

Sue,
As Smitty mentioned it is certainly possible for the pacemaker to stimulate ectopic beats.
Here is another thought. Something brought on your AV block in the first place. One of the most common causes is an infection such as a virus. The irritation of the heart conduction system brings on the ectopic beats, the pacemaker is implanted, but the irritation continues or gets worse. It seems like the pacemaker was the cause, but it is only coincidental.
I went through almost 6 weeks of ectopic beats that at one time were as many as 2500 per day with runs of 10-15 minutes of skipping every other beat. I resisted all the meds they wanted me to try and all of a sudden one day they were gone!
My son had the same problem and has had the same outcome. There have been a number of postings here as well. I suspect there is some unknown virus going around that may cause inflammation of the heart.

frank

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