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  • Q&A with Australian Health Practitioners

    My pacemaker is set at 70 with a resting rate of 60. Is this normal?

    When I am at rest my pulse drops to about 48 then to about 24.

    My technician says that my pacemaker is working perfectly at 70.
    Although it is ten years old he says that still has years of battery life and that I have total heart block with no natural beat.
    I am informed that the more I relax, the more my heart is producing pre-emptive beats that are causing the pacemaker to cut out.
    How can total heart block cause pre-emptive beats?

    I have just been given my sixth angiogram since 1994, looking for blocked arteries, which are always perfectly clean and large.

    I am a very fit 82 with no other health problems. I can power walk a kilometre and mow for an hour with no problems, but if I sit for ten minutes I have to go to bed because of exhaustion.

    What is wrong?

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  • Dr Michael Davis

    Cardiologist (Heart Specialist)



    Electrophysiologist and pioneer in catheter ablation and in the management of atrial fibrillation. Expertise in arrhythmia device therapy, coronary care, echocardiography.  View Profile

    Whilst it is difficult to be certain what is going on without recording an ECG at the time of your apparent slow heartbeat, almost certainly what is happening is that you are getting ventricular ectopic beats. These are “premature” beats which do not produce heart contraction strong enough to be felt at your wrist when you take your pulse. If they are repetitively after every paced beat, a pattern known as bigeminy,  then the pulse counted at the wrist appears to be half what it actually is. This pattern can cause symptoms such as tiredness. Because your pacemaker detects that your heart is beating on its own (and ventricular ectopic beats can happen despite heart block) then your pulse rate can appear to be below the programmed rate of 70.

    There are other possibilities related to pacemaker programming and function, so that the best way to be sure what is going on is for you to be attached to a pacemaker programmer while you have are having symptoms.  If this happens only occasionally then a 24 hour Holter or one week event monitor might be needed. I am very surprised by the number of normal angiograms you've had!

    Depending on what is going on treatment may range from nothing to changing your pacemaker program.  Medication is really required or necessary.

    By the way, there is no such thing as a “pre-emptive” beat. Maybe you misheard “premature” as this. I'd been talking to your cardiac electric physiologist/pacemaker doctor rather than the technician.

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  • peterauliff

    Healthshare Member



    I went to my Tech and showed him the last 7 days of BP readings (av 105/67  52) and asked him to reset my pacemaker back to 60 bpm, that was the setting before the report on ‘output at 30%’. He relunctantley agreed.                                 I returned after 7 days with  results of (av 113/76   60)             This showed that a setting of 60 gave stable Pulse and better BP from the point of ‘Output".               My Tech was most surprised, but agreed to stay on 60.     Could it also prove that my ’Output' was better on 60?     Since resetting to 60, I also have lots of energy and do not have to spend most of my day sleeping.                       On the subject of medication; I am on 3.125 Carvedilol and 20mg Telmisartan. (My GP wonders why!) and I would like to stop taking them as I dont like the body rash, dry mouth, constipation etc.      I am now on the waiting list at the hospital for a Holter Monitor.

  • Dr Michael Davis

    Cardiologist (Heart Specialist)



    Electrophysiologist and pioneer in catheter ablation and in the management of atrial fibrillation. Expertise in arrhythmia device therapy, coronary care, echocardiography.  View Profile

    Peter, firstly I do not understand what you mean by “output at 30%”.  Secondly it is not possible to tell from the information you provide why you feel better with the change in program. Thirdly, I'd say from your medications that you have abnormal heart function which would increase the possibility I suggested of ectopic beats. 

    See your cardiologist and make sure he explains everything to you and your GP including the rationale for your current treatment. 

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