Options for 2nd degree type 2 heart block when pacemakers ineffective

If your EP cannot figure out how to unblock your heart, assuming that's even possible now, perhaps you should go further afield and look for an internationally renowned expert with your conditions and see if that person would like to take a crack at you. You might make his/her week! 😀

Pacemakers primarily function to control the heart rate in patients whose heart rate is too low, they don't cure the underlying causes of that bradycardia, and they don't cure hyper- or hypotension. Pacemakers come with numerous functions and adjustments so that their pacing activity ( which consists of sending an electrical signal to either the atrial sinus node ( atrial pacing) and/ or to the ventricle ( ventricular pacing) as needed to keep the heart rate within the desired set ranges for the patient's activity is customized for each patient.

Often the settings on pacemakers are not optimum when the patient first receives a pacemaker, and these settings can be adjusted by the EP on subsequent visits as needed. Sometimes it takes a few visits to get to optimum settings for each patient, and it can be trial and error. But if the continued symptoms are due to not having the best settings for the patient, once these are achieved the patient will generally feel much better.

I'm not all that familiar with the leadless pacemakers, though I have read that they are useful for patients with heart block as they can pace the ventricles in time with the atrial signals which don't make it to the ventricles due to the conduction system blockage. I know they're also used in other cases as well. You mentioned your first leadless pacemaker was replaced, suggesting that was due to lack of relief of your symptoms, and onset of hypotension? Replacing the first leadless pacemaker with a second one would suggest that your docs thought there was a problem of some kind with the first pacemaker, but they still figured a leadless pacemaker was the way to go so they put in a second one? Is that pacemaker keeping your heart rate above the minimum set for it- generally around 60 BPM?.

Ok, so why don't you feel better? I can only speculate, but can't say for sure why that would be. It's possible the settings on that pacemaker are not optimized for you. If your dizziness comes on with exertion, perhaps the settings need to be adjusted to allow for a more appropriate increase in your heart rate with exercise? It could also be that your dizziness is due to other reasons than a low heart rate- that's a discussion to have with your doctors, but if that is the case, your pacemaker won't help.

In your shoes, I'd check with your EP and other healthcare providers for 1) possible adjustments in your pacemaker settings to optimize them for your activity and lifestyle, and 2) other causes for the continued dizziness and other symptoms you may be having. Best of luck!

I am fortunate in that my Abbot PM2272 pacemaker, installed by Dr Mohar at Sutter Health Roseville CA, is working great. It’s a wired system for regulating the right atrium and right ventricle.. An infection develop at the 5 week period and I have been through 2 regimes of powerful antibiotics. It appears as though the infection has gone away. Nevertheless, the surgery and infection has been a psychological game changer in my life. Iam thankful for every morning I wake up alive.