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Pacemaker advice

Heart Rhythm Conditions | Last Active: 12 minutes ago | Replies (20)

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@phil75

Thanks for your thoughts. I had a conversation with the doctor last night and we postponed the discussion about the PM until I go through a sleep study. This forum has been a big assist for me to make good decisions. Thanks again.

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Replies to "Thanks for your thoughts. I had a conversation with the doctor last night and we postponed..."

Sounds like a good idea if you're uncertain about needing a pacemaker at this point.
Just for your perusal, here is a link to an article that lists and discusses the criteria for pacemaker or ICD placement. Reading this article might help in that discussion you will eventually have with your doctor. I think these criteria were updated in 2019, the article is from 2023:
https://www.ncbi.nlm.nih.gov/books/NBK507823/
I've had a pacemaker for going on 6 years now- implanted for sinus node dysfunction in June 2019, and it was a game changer for me. I guess I went for about 2.5 years of being tired, with an low heart rate ( in the high30's, low 40's), intermittently at first but worse as time went on. It got to where the heart rate wouldn't go past the low 50's, even when I was active. This could have been due to the high dose of metoprolol I was taking to control the atrial tachycardia( with heart rates into the 170's) that dominated my life without the medication, though it seemed the bradycardia occurred at times that wouldn't be expected if it were just due to the medication. When I was referred to an EP, he discussed my options as including a possible ablation, though he was reluctant to ablate an atrial tachycardia, which he said was difficult to induce in an electophysiology lab. We tried my weaning off the metoprolol, and taking diltiazem ER to see if that would control the tachycardia and not cause bradycardia, if not he recommended a pacemaker. The diltiazem failed miserably , so I got the pacemaker. The EP had explained to me the progressive nature of sick sinus syndrome, so when I dragged my feet a bit about getting the pacemaker, the EP ( sarcastically, I think) informed me it wasn't a stat procedure, so if I wanted to we could wait "till I begged him to do it". That I understood.
I think the settings put in place by the EP at my first pre-op visit were optimal for me, when he set the rate response ( this allows the pacemaker to increase the heart rate to match the patient's activity) it made a huge difference. I no longer have those exhausted all the time, mind-nothingness that made me fear I was getting into dementia, as my heart rate is pretty much where it needs to be for my activities.
The pacemaker monitor also monitors and reports the heart's and the pacemaker's activities, so my cardiologist knows what is going on. I've also developed Afib over the last few years, though it's still paroxysmal and well controlled ( pretty much) with the metoprolol. As they said, this thing is progressive and apparently over the last couple years I have developed some heart block as well, so with pacemaker adjustments I'm paced close to 100% in the ventricle, as well as the 80-90% it had been in the atrium. So I guess at this point it's a lifesaver for this old gal (77) who didn't think a pacemaker was necessary. And at this point I feel good and can spend days on end not even being aware of my pacemaker or even thinking about it.

Just one more thing to mention as I'm not sure how well this is discussed in the article. One of the 2019 Class I criteria for pacemaker placement is symptomatic bradycardia caused by a medication for which there is no substitute. This would include rate or rhythm control drugs for individuals suffering from tachycardia but in which ablation is not an option. The pacemaker would keep the heart rate from going too low when the person takes that medication. I think that was one of the criteria under which I received my pacemaker, though I've had 3 cardiologists ( 2 EPs) all tell me that my sinus node issues were underlying, there anyway and just brought to light with the medication.

Anyway, good luck with all this!