What is done for Bradycardia and Tachycardia syndrome- if pacemaker -

@marybird
I too have bradycardia, It has been getting worse with age. I am a 77-year-old male, I am going to have a pacemaker procedure done in early December. Your article is very much appreciated!!
It is conforming to know it might help me as well,

Jim Gill

@earther Mary may not return here to reply early enough for your needs, so I hope both of you won't mind my (interim and substituted) reply.

A pacemaker is usually the last resort for a troubled heart that is working poorly........electrically. Even if a heart is in what is horribly termed 'heart failure', a pacemaker can correct a faulty rhythm and bring the heart almost back to it's normal state.....just because it fixes the rhythm. Remember that rhythm in a heart is not just lub-dub. It's actually several structures reacting to several nerve and sequencing signals originating from the sino-atrial node. With four separate chambers acting as pumps, it's not a simple function or process. Naturally, some people feel awful when they have the arrythmia, while some are quite asymptomatic; they have no sensation that anything is wrong, so they feel well, if a bit out of breath of feeling a bit unsteady on their feet for some strange new reason they don't understand.

The pacemaker can correct these faults and restore normal heart function, and with normal rhythm and function comes a rejuvenated heart in many cases. If there was any hypertrophy, it might reverse. It does in some people, not in all. This is an example of what can improve with a pacemaker, not mention that all those nasty symptoms might disappear in a few weeks. This means improved sleep, improved vision, improved cognitive processes, improved mood...you get the idea. So, a pacemaker offers a lot of promise to an ailing heart. Try to look at it that way. As far as I know, and no I don't have one, the implantation takes just a short while, not even real 'day surgery'. It's just a short procedure and you go home inside of a couple of hours.

Here's another little tidbit where pacemakers can help those who need them. Many of the "newer" pacemakers have settings that can be useful to limit the number of atrial fibrillation episodes in patients with pacemakers who have paroxysmal A-Fib. The settings program the pacemaker to pace such a patient up to a HR of 75 ( maybe a bit higher in some patients) when there is an episode of A-fib, with the idea of outpacing the Afib and stopping the episode. It may not work all the time, but I have paroxysmal A-fib and was informed that I have this setting turned on on my pacemaker. I wondered if I had it, I'd sometimes feel the familiar flutter and the "being in a falling elevator" feeling, sometimes a slight shortness of breath that sometimes accompanies my A-fib episodes ( I don't always feel them) and would feel/hear ( through my pulsatile tinnitis) a strong, regular faster ( than my usual 60 at rest) heartbeat that seemed to end the arrhythmia. Most of my A-fib episodes are short anyway, a few seconds to a few minutes, but it seems the pacemaker outpacing the A-fib makes most of them even shorter. I guess I'd have more longer episodes if it were not for the pacemaker.

There's also the monitoring function that comes with pacemakers/ICDs. These days they're generally paired with a monitor ( which can be a device that sits on your nightstand, or even a phone app) that your pacemaker communicates with via Bluetooth. This monitor sends reports from the pacemaker periodically at a frequency set up by your provider or your pacemaker clinic- generally every 3-6 months, or if one of the pre-set parameters is out of range ( indicating a potential problem with your heart or the pacemaker system, leads...). Your provider gets these reports and can monitor your heart/pacemaker at any time. So they know what's going on with your heart anytime they check. That's how my A-fib was picked up.

Of course those functions alone are not reasons for getting pacemakers, if otherwise you have no need for one. But for those that do, these functions can be valuable.

@marybird -- Thanks for replying, Mary -- and sorry for the delay in responding. Had no time and then had trouble logging in.

It's critical that I get my heart rate up, and I do that in good-weather months by pretty strenuous work outside. That setting you mentioned on the pacemaker wouldn't keep my heart from going above that just because I was working hard, would it?

There are a lot of similarities between your conditions and mine, but I have so many that I feel like a science experiment:

4 arrhythmias: AFib, bradycardia, PACs, SVTs
diastolic dysfunction: heart failure with preserved ejection fraction (HFpEF)
severely enlarged L atrium and enlarged R atrium
I take Eliquis, Spironolactone, Losartan, and Atorvastatin
And I'm 80, although people say I don't look or act my age (thankfully)

I've probably forgotten at least one key condition or factor, because it's just overwhelming. It started with noticing purple toes in 2010 then bradycardia by around 2014, brief blindness episodes starting around that same time (finally know, after pushing for "WHY?" for 11 years and a brain MRI in 2026, that's related to not enough blood getting to the brain because of heart problems). Heart failure diagnosis in 2016, and the heart rhythm doctor told me then that I'd probably need a pacemaker in about 5 years. So I've avoided it for nearly 10 years.

I've had an implanted heart monitor (loop recorder) since 2/2025, but it's my Fitbit that picked up the first AFib reports. I recently had 2 more serious AFib episodes, again that the Fitbit recognized but didn't send confirmation until hours later. I sent screenshots to the Heart Rhythm Clinic and asked them to verify on the heart monitor whether this was real or just a Fitbit error. It was real, although Fitbit showed higher than the heart monitor readout. But I've been waiting for clarification / verification from them for a week now.

I'm in a remote area, not the best place to be for best medical care. Plus, I couldn't even get an appointment for the neurologist at another medical center to tell me her assessment of the MRI because Medicare will no longer cover telehealth appointments, and I can't drive to where she is, an hour away, because of the risk of blindness episodes, serious AFib, or stroke.

So far, the best info I've had to consider about risk factors and for my decision re: whether to agree to a pacemaker and yet another Rx med or two is a long Q&A with Gemini, Google's AI. 31 pages when transferred to a Docs file! (NOT just the limited version that people see in searches, but the more in-depth version at Gemini.google.com.)

Hearing from people here who've been through this helps, too, and I greatly appreciate the details you provided.

@earther Looks as though there are a number of similarities in our conditions, at least in the arrhythmia department, though it looks as though I may have some other heart issues as well.
I'm not that much younger than you are either, I'm 78, though I'm still kicking along, active and plan to do so as long as I'm on this side of the grass! And I promise you, I thank G-d every day for my pacemaker, it's made that much difference in my life.

I wanted to address your question about the pacemaker "rate control setting", though there are many other settings on a pacemaker that address other issues, and these settings are customized for each patient. The lower rate is set on each pacemaker, this is the heart rate at which the pacemaker "kicks in" and sends an electrical signal to the sinus node in the atria ( and may or not send one to the ventricle as needed) which begins the next heartbeat. The default lower setting is 60 BPM, though this can be adjusted for each patient, the lower rate setting prevents the person's heart rate from going below whatever the setting is. The higher rate setting is the rate beyond which the pacemaker will not pace. That is also adjustable and varies with the person's activity and other needs. This upper rate will be higher for a very active person, higher than for a couch potato, and like all the adjustable settings on a pacemaker sometimes requires some trial and error to come up with the optimum settings for each person. My rate settings are 55-120, yet my daughter, who also has a pacemaker and is more active than I am, has settings from 75-175. These were set for her over some time and trial/error and she's happy with those settings. My upper setting was set rather low to avoid any overlap with an alarm setting on my pacemaker which notifies the pacemaker clinic if my heart rate goes over 140. With the rate settings, your heart won't go below the lower limit with the pacemaker, and if the heart rate is above the upper setting, it's not the pacemaker it's your own heart pacing itself ( or maybe a tachycardia, but not the pacemaker normally).

The rate response setting is also variable, depending on the patient's needs and activity. Some people don't need it, don't like it and for them it's not turned on. It's primarily used for patients with chronotropic incompetence, ie, their heart rates will not increase enough to support increased activity. This is another trial and error setting as it's hard to just select a setting when you aren't sure what's needed to support a patient's activity. Mine's worked out well and overall I'm happy with it. My daughter, on the other hand, had several visits to her cardiologist/pacemaker clinic, and they had her run on a treadmill to find the optimum settings for her, and sometimes that is what it takes. There are a few tradeoffs, for the rate response, though. Depending on the make/model of pacemaker, how the rate response works varies, and my pacemaker is a St. Jude Assurity model, and the rate response is a mechanical device in the pacemaker that responds to movement. So if I drive over a bumpy road, rock in a rocking chair, or sometimes when I flip over to my right side in bed at night, the pacemaker will pace my heart up to 100 or a little more. If the rate response is set at too sensitive a setting, the pacemaker can increase the person's heart rate too high at very little increase in activity- like in my daughter's case where her heart would be paced up to 120 when she got up and walked across the room. That needed adjustment, obviously, and it was for her. I'm ok with the few increases in HR over bumpy roads and I stay out of rocking chairs anyway ( they make me nauseated- motion sickness) and find those a small price to pay for the great job the rate response does for me.

As for settings with your pacemaker, those will likely be trial and error for you as you find the optimum settings for your activity levels. What can happen sometimes is that an active person may find that the upper setting of the pacemaker may not allow it to pace to high enough a heart rate to support that activity,(thinking of hiking uphill, running, swimming) and the person's own heart can't get that high on its own ( bradycardia). That might just require an increase in the upper rate setting, again, sometimes this is trial and error and they may be able to determine your optimum settings if you're able to run on a treadmill.

I hope this helps a little. If you've got well-documented bradycardia, and some serious symptoms associated with it ( if that includes the blue digits and periodic blindness those are new for me) it seems as though you'd benefit greatly from a pacemaker. In your shoes I don't think I'd hesitate to give your ok to get one. You do need a good cardiologist, preferably an eletrophysiologist (EP) to help you with this, and you'd need an ongoing relationship with a pacemaker clinic as they will monitor your pacemaker ( probably remotely) and make any adjustments on your pacemaker as needed.

I hope this makes sense!

@earther Looks as though there are a number of similarities in our conditions, at least in the arrhythmia department, though it looks as though I may have some other heart issues as well.
I'm not that much younger than you are either, I'm 78, though I'm still kicking along, active and plan to do so as long as I'm on this side of the grass! And I promise you, I thank G-d every day for my pacemaker, it's made that much difference in my life.

I wanted to address your question about the pacemaker "rate control setting", though there are many other settings on a pacemaker that address other issues, and these settings are customized for each patient. The lower rate is set on each pacemaker, this is the heart rate at which the pacemaker "kicks in" and sends an electrical signal to the sinus node in the atria ( and may or not send one to the ventricle as needed) which begins the next heartbeat. The default lower setting is 60 BPM, though this can be adjusted for each patient, the lower rate setting prevents the person's heart rate from going below whatever the setting is. The higher rate setting is the rate beyond which the pacemaker will not pace. That is also adjustable and varies with the person's activity and other needs. This upper rate will be higher for a very active person, higher than for a couch potato, and like all the adjustable settings on a pacemaker sometimes requires some trial and error to come up with the optimum settings for each person. My rate settings are 55-120, yet my daughter, who also has a pacemaker and is more active than I am, has settings from 75-175. These were set for her over some time and trial/error and she's happy with those settings. My upper setting was set rather low to avoid any overlap with an alarm setting on my pacemaker which notifies the pacemaker clinic if my heart rate goes over 140. With the rate settings, your heart won't go below the lower limit with the pacemaker, and if the heart rate is above the upper setting, it's not the pacemaker it's your own heart pacing itself ( or maybe a tachycardia, but not the pacemaker normally).

The rate response setting is also variable, depending on the patient's needs and activity. Some people don't need it, don't like it and for them it's not turned on. It's primarily used for patients with chronotropic incompetence, ie, their heart rates will not increase enough to support increased activity. This is another trial and error setting as it's hard to just select a setting when you aren't sure what's needed to support a patient's activity. Mine's worked out well and overall I'm happy with it. My daughter, on the other hand, had several visits to her cardiologist/pacemaker clinic, and they had her run on a treadmill to find the optimum settings for her, and sometimes that is what it takes. There are a few tradeoffs, for the rate response, though. Depending on the make/model of pacemaker, how the rate response works varies, and my pacemaker is a St. Jude Assurity model, and the rate response is a mechanical device in the pacemaker that responds to movement. So if I drive over a bumpy road, rock in a rocking chair, or sometimes when I flip over to my right side in bed at night, the pacemaker will pace my heart up to 100 or a little more. If the rate response is set at too sensitive a setting, the pacemaker can increase the person's heart rate too high at very little increase in activity- like in my daughter's case where her heart would be paced up to 120 when she got up and walked across the room. That needed adjustment, obviously, and it was for her. I'm ok with the few increases in HR over bumpy roads and I stay out of rocking chairs anyway ( they make me nauseated- motion sickness) and find those a small price to pay for the great job the rate response does for me.

As for settings with your pacemaker, those will likely be trial and error for you as you find the optimum settings for your activity levels. What can happen sometimes is that an active person may find that the upper setting of the pacemaker may not allow it to pace to high enough a heart rate to support that activity,(thinking of hiking uphill, running, swimming) and the person's own heart can't get that high on its own ( bradycardia). That might just require an increase in the upper rate setting, again, sometimes this is trial and error and they may be able to determine your optimum settings if you're able to run on a treadmill.

I hope this helps a little. If you've got well-documented bradycardia, and some serious symptoms associated with it ( if that includes the blue digits and periodic blindness those are new for me) it seems as though you'd benefit greatly from a pacemaker. In your shoes I don't think I'd hesitate to give your ok to get one. You do need a good cardiologist, preferably an eletrophysiologist (EP) to help you with this, and you'd need an ongoing relationship with a pacemaker clinic as they will monitor your pacemaker ( probably remotely) and make any adjustments on your pacemaker as needed.

I hope this makes sense!

@marybird
For me, and Cardiologist and Pacemaker, we do video appts and with the pacemaker feedback unit by the bed, they are updated as often as your care requires and details and adjustments can be made with video appts.
All of us have our own set of needs and for my needs I needed a pacemaker. But I have had an extra 25 years, on 4th pacemaker . Distance to Dr not a problem anymore. Just a cell and video appts. God Bless.
Do I like the invasion of my body and that would be no.
But is it tolerable, it is. And glad to be 94 yrs of age. The pacemaker definitely the golden key for me.