Post pacemaker implantation

[nidoman]

Dear Doc,

This question is in behalf of my father

His History: Renal failure patient since 2001 having thrice a week dialysis developed hyperparathyroidism with PTH at around 5000 which improved to 2000 by use of cinacalcid, had complete heart block this feb (bradycardia) and pacemaker was implanted. His EF is good 55% although RV function is poor. Now he had no prob with pacemaker and his pulse was always around 80 until last week when at dialysis his pulse rate fell to 43 on the monitor (lower rate was set at 50) he immediately came off dialysis and now this is his third dialysis and during dialysis his heart rate falls into 40s and post dialysis it improves. Doctors checked the pace maker n they say its ok and the x-rays also show initial positioning of the pacemaker.

We are really worried abt him. What could be the reason of this problem as nobody is so far able to diagnose it.

[nidoman]

Sir the problem is persisting I have scanned his ECO, EKG and Pacemaker check reports. is there any way i can share them with you so u have a better idea about the situation and will be in a better condition to help me. Thanks.

[Michael J. McWilliams, M.D.]

The only reliabe way to see the pulse is on an EKG or through the pacemaker.  If a machine is counting it and there are premature beats, heart rate is often underestimated.  This is a common reason referring doctors ask for a pacemaker to be checked.  Next time the heart rate is counted low, have them check an EKG.  That is my best guess as to what is happening.