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Avatar universal


  To answer my question, I need to give you some medical background. I had a tripple bypass done in
  March 1991. My problem was found on a routine physical. I had no heart attack symptoms or problems.
  My cardologist found that I have had sometime in my life, a heart attack. He said that it probably happened
  in my sleep or I passed it off as heartburn, So I do have some heart damage. The doctor said it is minimal.
  I lead a very active life. I've always been physically active. I presently lift weights and walk daily on a
  treadmill. I also play golf and do heavy yard work (which I enjoy).
  I just had a physical done and the doctor said that my heart rate is very low. I normally have a heart rate
  in the high 50's and at rest it usually is in the high 40's. He placed a 24 hour monitor on me and the alarm
  went off during the night. I fould out later it was because my heart rage dropped to 40 in my sleep.
  I see my doctor every three months so we communicate very well and he has taken terrific care of me.
  Since he told me that I may need a pacemaker in the future, I am really full of questions.
  My questions are the following:
  1. How will a pacemaker effect the lifestyle that I listed above?
  2. What kind of restrictions can I expect from a pacemaker.
  3. What is the cost of pacemakers?
  4. Are they generally covered by health plans?
  5. How often do they need to be replaced?
  6. What is the next step after Pacemakers?
  7. Could there be another blockage causing the heart to slow down?
  8. What is the life expectancy of someone who requires a pacemaker at the
      age of 51?
  I just had a stress test done in March of this year. I have one done every year. My family doctor has me
  on asprin daily and other medicines to control my cholesterol problem. None of the medications that he
  has perscribed slow down the heart. He has checked my prescriptions.
  Any information you can give me will be helpful.   Thanks.

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Avatar universal

  Dear Gary, thank you for your question.  Your doctor noted that you have
sinus bradycardia which can be normal in someone who is in good shape like yourself.
I'll answer your questions individuallly and then summarize at the end.
1) If you require a pacemaker, you shouldn't have many restrictions on your lifestyle.
For the first month after a pacemaker insertion, you couldn't lift weights, but
after that, you should be able to exercise and do the activities you describe.
2) There are mostly logistic restrictions with pacemakers.  For example, a pacemaker
would set off a metal detector so you couldn't go through one with a pacemaker.
Also, an MRI couldn't be done because it could dislodge the pacemaker.  But, from
a physical activity standpoint, it depends on what kind of pacemaker is inserted
and how much the pacemaker is actually required for sustaining the heartbeat
to determine restrictions.  In your case, if a pacemaker is needed, it probably
would only be used when your heart rate becomes too slow and you would not be
dependent on it.  Thus, I doubt there would be many restrictions in your case.
3) The cost of pacemaker is mostly up front and includes the time in the
laboratory for insertion, the device itself, and the physician fees.  The total
costs are usually $10,000 - $15,000.  Costs after insertion are minimal and
relate to periodic checking of the battery and leads.
4)  For most indications, pacemakers are covered by insurance plans.  There are
established guidelines for indications for pacemakers and I assume those would
have to be met for reimbursement to be complete.  You should talk with your physician
and insurance company about this issue.
5)  The pacemaker is powered by a battery/generator implanted beneath the
collarbone.  The battery usually lasts 5-7 years depending on how much the pacemaker
is used.  Replacement of the battery is a simple outpatient procedure.
6)  I'm not sure what you mean about the next step after pacemakers.  There
are no alternative therapies presently for rhythm disorders that require pacemakers.
Pacemakers have advanced greatly in the last 15 years and are here to stay.
7)  Blockages in the coronary arteries typically do not cause slow heart rhythms
unless a heart attack has occurred and the electrical conduction system is damaged
by the heart attack.  Thus, I doubt a new blockage has caused your slow heart rate.
8)  A pacemaker should not limit your life expectancy.
Since your family physician checked your medications to ensure that none would
slow down your heart rate, that cause of a slow heart rate has been ruled out.
If your heart rate is as slow as 40 and you're not having any symptoms like
dizziness, light-headedness, or loss of consciousness, then it's doubtful you'll
need a pacemaker.  However, if those symptoms develop with a slow heart rate,
a pacemaker may help.  You may not need a pacemaker in the end but you should
have another discussion with your cardiologist about this subject. I hope you
find this information useful.  
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.  

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