Pacemaker Syndrome

[chkbkr]

Received dual chamber pacemaker 4 wks ago, leads are in RV apex and RA apendage. Holter showed rate dropping to 22 bpm at night, EKG showed A-flutter at 300bpm before implant.  Drs say I may have blocks at or below AV node. Am otherwise very active & healthy except I take avapro & HCTZ for high bp and lipitor.  Parents & Gparents lived well into 80s, 90s and one over 100.  Heart in excellent cond. mechanically.  Comfirmed by echo, cardiolite & angiogram. On coumadin & scheduled for cardioversion next wk and ablation in 2 mos.  QRS went from 104ms before implant to 166ms now. Heart now has unpleasant pounding sensation.  Having dizzy spells with bp dropping from 130/85 to 100/75 sometimes with PVCs that cause pacemaker to skip beats.  Pacer in DDDR mode only paces RV at 80 bpm because of flutter. When I exercise rate goes to 100 bpm apparently inhibiting pacemaker, pounding stops & I feel much better.  I have read about the bad things long term RV pacing can cause even leading to heart failure. Question - If I cannot be restored to sinus rhythm or be paced physiologicaly from RA what are my options?  Other pacing sites?  Different type of pacemaker?  Something else?  I do not want to go on antiarrhythmia drugs long term because of scary side effects.

[PikaPika88]

Hi Dotty,

I'm very interesting.  How do you find out you were in heart failure?  Wasn't your pacemaker kept pacing?  Heart rate should be normal?  How do I know my heart is working or not if the pacemaker keep constantly pacing at 70?

I already had my His bundle ablation.  Pulse dropped to 40 when I woke up from ablation.  Dr said, the AV node was damaged a little bit.  How come I still have A-Fib?  How come I am still so unwell and unwell and unwell..........?  I'm very upset.....

Pika.

[DottyCece]

I had Atrial Fib/Flutter for a long while and nothing worked included three ablation attempts, drugs.  I had multiple cardioversions (11 of them).  So ended up having an AV ablation and then being pacemaker dependent. I had the dual chamber kind (right atriaum lead and right ventricular lead.  Three months later I was in heart failure with an EF of 30%.  They changed the pacer to a biventricular device and an ICD.  With heart failure drugs and the pacemaker and daily exercise, I am about 45% EF and feeling much better.  I have always thought it was largely pacemaker related.

[chkbkr]

Hi PikaPika88
Cardioversion is synchonized shocking of the heart to try and get it back into normal sinus rhythm.  Dr said it would be better to be in this condition before ablation.  Try doing a Google search on "pacemaker syndrome" and you will see the reasons for my concerns.  Collection of things that happen when both ventricles aren't beating together including A-fib.

You sure have my sympathy for the way a pacemaker can make your heart & chest feel. Believe it comes from right ventricle contracting before left rather than both together like they are supposed to.  My understanding is that A-fib just looks like noise on an ECG trace while flutter looks like a sawtooth waveform.  My Dr told me you don't want to have either long term because that causes bad things to happen too including as much as a 25% drop in heart pumping efficiency.

[PikaPika88]

That "shocking" makes your vision all wipe out!  You'll start chasing the oxygen (breathing)!  And my point is: How long it stays in the normal sinus rhythm?  Mine one was started as soon as I walked out of the Dr's office.  Here comes the "TRAIN"!

Anyone, after the "shock" the normal sinus rhythm can stay more than one day?  I'm very very happy if it can let my "TRAIN" has a one day break (holiday).  How long were yours one (normal sinus rhythm) lasted after the "shock"?

Pika.

[PikaPika88]

Hi Chkbkr,

"scheduled for cardioversion next wk" What is this mean?  A "shock"?  Why you want that?

I have an almost similar pacemaker like yours.  I'm currently on DDIR mode.  My both leads are in the right side too.  Dr said I have A-Fib.  But I never seen one ECG showed that had an A-Fib!  I had my his bundle ablated but still showed wpw.  I thought I had been fixed up 20 years ago.  very upset!

I'm feeling my chest has an elephant sit on that most of the time.  If the elephant went for a walk then the train came!  It is either the "express train" or "train stops all station"!  Someone told me pacemaker can cause A-Fib.  I'm really want to find out was mine one too?

Pacing Right ventricle can cause LBBB.  Told by medhelp in my thread.  I have a mildly enlarge left ventricle.  History in pacemaker: 12 years in one lead, placed in right atrium.  11 years in 2 leads.

Hope you can share your pacemaker syndrome with me.

Take care.

Pika.

[Cleveland Clinic]

chkbkr,

If I cannot be restored to sinus rhythm or be paced physiologicaly from RA what are my options?

There are a variety of pacing modes that might help alleviate your symptoms. First, I would make a serious attempt to get back in sinus rhythm if that has not been tried. I wouldnt be overly concerned with the pacing site for now. Todays devices have several modes that can be adjusted to try to alleviate pacemaker induced symtoms.

Other pacing sites? Different type of pacemaker? Something else?

Your leads are not easy to switch once implanted. As I mentioned your device, since a newer model, porobably has many different variables that can be tried to alleviate your symtpoms.

I do not want to go on antiarrhythmia drugs long term because of scary side effects.

Flutters often have pretty good success with ablation. hopefully you wont need an antiarrythmic medication at all.


good luck