Increase PAC/PVC after PM

[worriwart]

Dear Doctor: 5 weeks ago I had a Medtronc Sensia PM placed for 2nd Degree Heart Block. (My past H/O is IST, RBBB, and normal Echo ) I have had to have it fine tuned a few times as I was sure I could "feel" it pacing.  But my question has to do with what seems to be an increase in PAC/PVC's and more freq bouts of tachycardia.  They seem to occur most often when I feel abd distention (I also have IBS) and usually with exercise.  I had a "hand-held" event monitor to try and catch these episodes, generally my HR was aroud 120 and the doctors also detected some PAC?PVC activity.  Seems it feels worse than it is, I guess, because I'm told to calm down.  I also had a 12 lead ekg done during one  particularly difficult day to r/o a-fib.  Which I guess was r/o. I'm already taking Tenormin 50g BID and really don't want to increase or add to the meds.  These spells happen about every other day or so and make me very aware of a bloated feeling, sl sob, and sometimes I feel like I'm having a hot flash.  I used to get these "spells" maybe once every 4-6 months, had even been t the ER but generally sent home with dx of pac/pvc, no MI.
Can you shed some ligh on this?  I am seeing an EP doctor, he told me tht during the study he could not elicit any dangerous ventricular arrythmias, but even so, I'm feeling very concened.  I admit my anxiety level has been increased since the PM and these spells happen more freq after a night of sleeplessness
Should I request any special test, event monitor etc.?  Can ths happen after PM and why?  Any other words of wisdom would be appreciated.  I'm pretty nervous about all this. Thankyou

[Michael J. McWilliams, M.D.]

anytime.

[worriwart]

Just wanted to thankyou for your reply. I appreciate your thoughts and suggestions.  Sincerely, worriwart

[Michael J. McWilliams, M.D.]

Can you shed some light on this?  

Inappropriate sinus tachycardia may explain a lot of your symptoms.  Not the fast heart rate itself but the inappropriate sinus tachycardia is a form of autonomic dysfunction that overlaps when many of the symptoms as fibromyalgia.  I am not giving you a diagnosis of fibromyalgia, but what I am saying is that people with IST have many of the symptoms you describe.  I always tell my patients that we can control your heart rates with an ablation, pacemaker or medications, but many of the symptoms are related to the heart rhythm itself but your bodies perception of these rhythms -- IST patients are often hyper aware of their rhythm even when it is normal.  They also tend to have temperature regulation issues and non specific abdominal complaints like bloating and constipation.


Should I request any special test, event monitor etc.?

The pacemaker is essentially a heart monitor.  It will give maximum values, minimum values, detect how active you are, etc. If you have a structurally normal heart and a negative EP study, you don't need to worry about your heart rhythm.

People commonly complain about increased palps after sleep deprivation and stress.  If you are constantly anxious about the rhythm and the rhythm is worsened by stress and sleep deprivation, it becomes a sort of positive feedback loop that can feed off itself.  The key is biofeed back to keep yourself calm, but you have to believe your OK before this works -- it doesn't sound like you are their yet.

Can ths happen after PM and why?

If you are requiring ventricular pacing, some people will have symptoms with that related to increased related to right ventricular pacing.  If you aren't pacing much, it is more difficult to explain.

it is tough to say anything with certainty of over the internet with out seeing the device interrogation, but most of the symptoms you describe are consistent with  IST and the typical related symptoms.  I still believe that you have to believe that you are well before you can convince yourself that you are ok.

I hope this helps and that you find relief soon.