Bradycardia - Pacemaker

I have been having problems with exercising for 4 years (dizziness when trying to run and bradycardia AFTER aerobic exercise stops). My current diagnosis, after a catheter and an EP study(which ablated an atrial flutter - did nothing to change my situation) is that I am experiencing many premature beats followed by long pauses. I am told my conduction system is fine but I should consider a PM because meds have been unable to regulate this rhythm. I have no problems until I do aerobic exercise and then again my bradycardia occurs after I stop exercising. It usually corrects after 1-1 1/2 hour but on 3 occasions in the last year it lasted >10 hours (40 bpm at rest, rate can go up with activity to 70-80, but accompanied by SOB). Questions (1)Have you seen cases like this - exercise only bradycardia?  (2) Aren't PM's prescribed when you have bradycardia at rest? (3)What testing should be done in my case, before a PM is implanted to confirm that a PM will help?  (4) I would consider a PM to help me to do more exercise, but what are the chances that it won't or I will need to make meds also ? Thanks.

[CCF-M.D.-MJM]

Hello,

(1)Have you seen cases like this - exercise only bradycardia?

Knowing your age is also important, but it sounds like you are chronotropically incompetent (you heart rate does not increase to appropriate levels with exertion).  This is a common indication for a pacemaker and yes we do see it often.

(2) Aren't PM's prescribed when you have bradycardia at rest?

Any symptomatic bradycardia including relative bradycardia.  I assume when you say it can go up to 70-80, that is with exertion.  I would expect even a well conditioned athlete to increase by that much by walking up the stairs.

(3)What testing should be done in my case, before a PM is implanted to confirm that a PM will help?

In my office I would either order an exercise stress test or take you to the hallway or some stairs and have you walk up them.  If you heart rate doesn't go up adequately, that would be enough proof for me.

(4) I would consider a PM to help me to do more exercise, but what are the chances that it won't or I will need to make meds also ?

From what you have written above, it sounds like it will help you.  Obviously if you were in my office I would ask many more questions, but this format does not allow for that.  I am not suer what other medical problems you have to require more medications so I can't really answer that portion of your question.

It sounds like you need a pacemaker.  If you are in doubt, obtain a second opinion.  Implanting a pacemaker should not be taken lightly, but it does sound like you would benefit from one.

Good luck and thanks for posting.

Thanks.

[axg9504]

What intrigues me is that it takes sustained exercise, generally running that gives me bradycardia. For example, if I were to run up the stairs as the doctor suggested he would have me do, he would see nothing but a nice increase in bpm. If he had me run for a while, he would find that I would get out of breath and have to stop. If I attempted to continue at some point I would get dizzy. My bpm is now 90. I'd like to know if any of you reading this have had a PM put in for similar problems or know of anyone? Thanks!

[Big Worm]

For the past year, I have been taking a Betablocker called attenolol, a generic.  It was prescribed at my 2005/May physical because I was continuing to have occasional arrythma, heart racing at various times.

I didn't have too much occasion to go back to the doctor over the next year.  Slowly, over the past year, I began to notice things, but didn't connect to betablocker:  shortness of breath, tiredness, constant feeling of tightness in my chest, left side, less ability to get prolonged erections, if any at all.

Recently I was scheduled to have elective eyelid surgery (ptosis was the diagnosis), where there is too much eyelid and it droops and blocks the vision.  To prepare for the surgery, I had to have certain tests done, and I did them in conjunction with my annual physical.  My pulse at rest was in the 30's--33-39.  My doctor cut my medication in half, and I checked my pulse for another week. No change.  The surgeon had my doctor test me for clotting (she did not know about the low heart beat) and that was ok.  Just before being wheeled in for surgery, the anesthesiologist and surgeon sort of panicked about my 38 beats a minute, expressed concern that my pulse would probably drop into the 20's and perhpas cause lack of oxygen and blood flowing to the brain.  Thankfully it was canceled.  Notified my doctor and he then took me completely off the beta blocker, and has scheduled an appointment for a week from now.  At my physical, he mentioned that one of the possibilities, pretty far down the road, was a pacemaker.  

Anyone out there who has had a similar problem with heart irregularity and used a beta blocker and had these side effects.  I'm not afraid of a pacemaker.  I don't think I've ever had a high heart beat, maybe in the 50's or low 60's. I've never been able to get my pulse up to 100. My blood pressure has been 130 over 70 for years, no problems there.

Thanks for any feedback.  Not sure if I come back here to see if there are comments or someone will e-mail me at ***@****    Thaks. Wayne