Pacemaker

[nantynannie]

Hi Everyone,

I was wondering if anyone had a pacemaker and if it was effective? I am thinking not, but just looking for anything that might work.

Thank you,

Ann

[cardiactec]

sinus node ablation and pacer therapy is contraindicated in POTS patient population. In most studies, the majority of patients who underwent such therapy were worse off than before sinus node modification/pacer therapy.

The distinguishing factor in POTS population vs. those that have other conditions truly requiring pacer therapy is that in POTS patients, the theory is that the sinus node rates (sinus tachycardia) that presents is actually a mechanism (defense mechansim by the heart) to help compensate for something else that is "broken", essentially to help maintain/sustain patient's blood pressure to various degrees so that patients do not pass out. some people still DO pass out, but overall the heart IS compensating by beating faster to maintain adequate blood flow to the brain - ie: maintaining blood pressure regulation.

a good EP would know this and would not even suggest pacemaker therapy/sinus node modification in POTS patients.

I dont know your story, so perhaps there are other issues you have along with POTS that requires pacemaker therapy.

I know there are a couple people on this site who have had sinus node ablation and became significantly worse off having gone in for SA node ablation and in turn having to have pacer therapy. morgan, i believe is one of these people. sorry for putting you on the spot morgan - i think you should chime in on this discussion since you have first hand experience here!

take care.

good luck to you.

cardiactec.

[taylortotmom]

Hi, Ann.

Some of us do have pacers- including myself, and did not require ablation. My pacer was implanted as a last resort to try to help with the bradycardia I get at night- bradycardia as opposed to dealing with tachy (which I also have but the pacer only helps the brady) . So, it really is an individual thing- it certainly is not an end-all be- all solution. The biggest effect for me is my mornings are much easier- still rough but nothing like they were pre-pacer. The pacer was something my doctor and I discussed heavily for a year before finally deciding to go for it- and again, as a last resort. So, it is not a typical solution but it IS a solution for some.

Hope this helps,

Carmen

[Sophia3]

pacers only help bradycardia...slow HR

But if it's low BP and tachycardia not a help.

[nantynannie]

pacers only help bradycardia...slow HR

But if it's low BP and tachycardia not a help.

Thank you for answering. I thought a pacemaker helped both brady and tachy. I saw another post for some new pacemaker...does that one help? Thanks!

[cardiactec]

I havent heard of a new pacer.

should have clarified in the above, as I assumed you also were referring to an ablation of the sinus node to rid yourself of your tachy, which would then generally include having to have a pacer - what happens or has happened in people who have gone in for sinus node modification (basically patients with inappropriate sinus tachycardia) is the sinus node becomes ablated (burned away) because docs have thought that the sinus node was the culprit of the tachycardia in pots patients/inappropriate sinus tach patients and then the heart is left with having to have a "different" source for electrical impulses of origin, enough to sustain pressure, etc (because generally the sinus node is where all electrical activity starts, and has a resting intrinsic rate of about 60-90). if the sinus node is eliminated from the equation, patient's are/can be left with rates that drop so low that it then requires a pacemaker. this is what i thought you were referring to.

have you tried all meds? florinef ? midodrine? beta blockers?

[morgan617]

Sorry, broken collar bone and ribs have prevented me from being on the computer much.

I had ablation in 2003 for tachycardia. I never worked again. The tachy was the only thing compensating for me. Eventually my tachycardia came back anyway. The EPS I have now flatly refuses to ablate people with autonomic dysfunction.

That being said, in 2006, I started having partial syncopal episodes, as soon as i hit the ground, I came to. I was convinced it was heart related, but couldn't convince my doctors.

Dave, my hubby finally took me to the ER one night because I was having awful arrythmias and was very symptomatic with them. They discovered I was going from rates of 130-150 to 25 in about 3 beats, hence the falling on my face. I finally got put on an event monitor, which recorded these events and had a pacer in less than a week. It was for tachy-brady syndrome.

I know of NO pacer that corrects a heart rate that's too fast, except for internal defibrillators for ventricular tachycardia, which is completely different than sinus tachycardia. Pacemakers are for people who's rates drop too low. My rate will never go below 60. It will record anything above 150, but it won't do anything about it, it is for information only when they "interrogate" my pacer every three months.

The pacer has been very effective in assuring that my rate will not go below 60 ever again, but it does not help in any other way. I appreciate what it is meant for, but fully understand it's not going to help anything else.

If they had pacers that helped with both, my EPS would be calling me to get it placed yesterday. Whether the ablation caused the need for the pacer is debated by everyone. ( scar tissue, damage, whatever) I can tell you from the standpoint of the reason I got it, I am very pleased, but I also understand that's all it's going to do.

I hope that helps a bit. I'm very foggy anymore, but that's kinda my story in a nutshell. Hey hey hey cardiatech!!! morgan

[flop]

At the moment you can get a pacemeker that treats slow HR by sending electrical impulses to the heart to beat faster.

There is another type of device called and ICD (implantable cardioverter-defibrillator). These are used in a very small group of patients with dangerous ventricular arrhythmias. An ICD can work like a normal pacer for treating THR but it also senses the dangerous rhythms and paces the heart very fast to try to get control of the HR, if that doesn't work then it can deliver an electric shock to the heart to try to stop the dangerous rhythm.

The ICD only works for dangerous ventricular tachyarrhythmias, it can't do anything to treat the sinus tachycardia of POTS or SVTs.

The only real reason for a POTSie to get a pacemaker is if you have heart recordings showing very slow HR at the same time as symptoms, or if your heart pauses for several seconds and it causes you to blackout.

Flop

[goldicedance]

I got a pacer back in 1996, right after a sinus node ablation that caused bradycardia. Right after the ablation, I began seeing an EP who really was chagrined that I had gotten that ablation.

I understand there is a new pacer put out by Biotronics that can compensate for drops in blood pressure. That pacer also has an upper paced limit of about 160, rather than the current 120.

I probably will get this new pacer in the not-too-distant future when I decide where to have it done - Ohio, Florida, or Maryland.

Morgan, dear, would this type of pacer be useful to/for you?

Lois

[morgan617]

Lois, Hi there sweetie! I think the atenolol keeps my rate under really good control at this time, so between that and the pacer I have, I think it would be fine with me to stay like I am. Nothing seems to go very smoothly for me anymore, and right now I sort of feel like if "it ain't broke" I don't want to mess with it.

My primary is totally convinced the ablation is the reason I now have a pacer. I think I am too. The future of medicine in the areas of heart disease is pumping along at a good clip, so who knows, I may be eating these words in a year or so! morgan

[goldicedance]

Morgan, dear...my cardio said the ablation caused the need for the pacer, too...the ablation caused bradycardia as well as junctional tachycardia.

Oh, my!

[morgan617]

Hindsight is always 20/20 and there is always going to be someone willing to mess with things they know nothing about, at our expense. Double oh my!!!

My SA node may have burned out at some point anyway, we will never know, but I am pretty positive the ablation sure speeded it along. It's kind of sad, as I used to take care of people who had ablations for what they were intended for, and they always did so well. What a rude shock to realize what it did to me......spilt milk I guess. morgan

[nantynannie]

Thank you for all of the answers!!! I definately wasn't thinking clearly on this one, just reaching I guess. When I had my TTT, the cardio wanted to discuss ablation, which I refused of course...but I came across an article about pacemakers and I wrongly assumed pacemakers regulate the heart rate no matter what it is (low or high). Obviously, I wasn't considering the fact that if our heart rates didn't compensate for the BP, blood pooling, etc., then we would all be on the floor! Just wishful thinking I guess.