I have Bradacardia - when do I need a pacemaker?

@joseph9
I have had a ICD/Pacemaker for almost 20 years (on my 3rd device).

Most of the time a pacemaker is implanted it is because you have an electrical problem and heart needs to be paced to offset the issue that it is.

I think I read you do not have any issues with your heart when exercising or at rests. That indicates your heart is naturally responding to exercise and at rest. You did not mention if you have PVCs so assume you don't. What is your BP? A low PR could cause low BP but you do not state dizzness.

The normal at rest HR is 70 bpm. What does that mean. It does not mean your HR is abnormal if below or above that number just means with combining all numbers this is an avearage. Those with strong hearts will normally have low pulse rates because heart functions so well.

You wore a heart monitor which would have shown electrical problems. So what you have is a low HR but if I read correctly not side affects. Many athletes have low HR. My resting pulse rate before I got my ICD/Pacemaker was 60. I exercised all my life.

Why did I get one. I have heart failure. My EF was going down and when it reached 30 a need for ICD is warranted. I went to Mayo Jacksonville EP for second opinion and he concurred need but wanted to do a dual device on having a pacemaker also. Why, because I had electrical problems in my heart including a left bundle branch block.

When I was put on new medication at Mayo (Entresto and carvididol) with my new HF doctor it caused my HR to go down into 30s. It also affected my BP and would get dizzy standing up and the low pulse rate was causing a lot of PVCs. So my pacemaker was set to 70 bpm.

Don't have answers for you but if no electrical problems, no dizziness, and cardiologist does not feel you need one work with them on your questions and concerns. If you do not like the answer get a second opinion.

My HR has always been 45-55. Most of my docs are not concerned. One wants my exercise rate at 125. Not gonna happen. With heavy workout I can get up to 90.
Dx benign accelerated idioventricular rhythm. No meds. Holter monitor once a year. Echocardiogram shows no abnormality except enlarged left atrium.
For now, I figure it's just the way I am, and maybe a heart rate at 1/2 means it will beat twice as long.
p.s. recent chemo tx got my blood pressure to normal-cancelled high bp meds🤷.

@shmerdloff
I think your post echos that the norms does not mean the norm for you.

You have low HR and has always been that. Sound like it comes from good exercise routine.

My HR was always in low 60s as avid exerciser all my life. When I went on Entresto and Carvididol it dropped to 30s. So my EP raised my pacemaker to pace me at 70 bpm.

The 70 was done to counter the PVCs I have been getting now for years. We experimented with different pulse rates, 50,60,70 finding the 70 had the lowest PVCs.

Now since I have a low pulse rate naturally and from medications my HR will not get high at all usually even when strenuous will be in low 100s just like your staying low.

I received a pacemaker December 2024, for Bradacardia, Electrophysiolgist said it would help with the issues of bradacardia,
My heart rate only dropped to around high 40's to 50's when inactive, and during sleeping.
It now controls it no lower than 60.
Take care

thanks
My HR drops to 30's while sitting and then fluctuates often lower. At recent DR appointment for a knee xray my HR was 40.
I have a pulse/oximeter that i use to check my heart rate which i can use when I am inactive. I got an Apple watch today and i hope i can get a better idea of active and inactive rate and level of fluctuation.
i'll let you know how it goes.
thanks again

Careful with otc devices etc. They can be inaccurate. Calibrated, my Omron wrist bp/hr is many points lower than the hospital. My oximeter shows good Sp02, but cannot show a reliable pulse ----/___-----__/. It sent me to the ER false alarm. It's supposedly a good one

Thanks
I just obtained an Apple Watch as I wasn’t confident in the HR/oximeter

I have been comparing and it is within 1 or 2 HB.
My heart rate rises to mid 50’s as I walk or move around but drops very quickly to low 40s when I reduce activity. As last week I went to Dr for a knee xray and my HR was 40.
I’m most concerned as I wake in morning my HR is often in 20’s
I ll see what it is tomorrow morning with my watch.
I plan to record my HR through the day so I can forward to cardiologist
Thanks for contacting me
Joe H

https://www.ncbi.nlm.nih.gov/books/NBK507823/
These are the latest guidelines for pacemaker implantation put in place by a task force from the American Heart Association, American College of Cardiology, and the Heart Rhythm Society. The article presents and discusses these guidelines.

Sounds as though you may fall into the Class II category under sinus node dysfunction ( just speculating here, I;m not a doctor), which lists documented bradycardia under 40 BPM without a clear correlation between the bradycardia and symptoms ( which would include dizziness, shortness of breath, chest pain). This category indicates there could be benefits from pacemaker placement, but there are differences of opinion about specific circumstances under this category. Or at least this is how I understand it.
It's a long article, but I found it very informative.

Thanks, I will read it
This must be what my Dr referenced regarding not recommending a pace maker
For me.
Thanks again
Joe H

My cardiologist told me if having incidents of passed out or almost passed out because of low rate of heart beats, that would be indication for need of a pacemaker.