So you’re getting a pacemaker (part 1 of 2)

September 18, 2014

2014-10-06 14_53_10-Miltimes 9-18-14 issue.pdf - Adobe ReaderIf you have a heart rhythm disorder, you may have considered getting a pacemaker – but you’re wary of having a small electronic device implanted inside your chest. Is it worth it? Ongoing heart rhythm problems make some patients faint and blackout. They can sap people’s strength and sideline them from activities like sports. In these cases, pacemakers may allow them to participate more fully in life. Here are some device basics and how life changed for three people with pacemakers: Wake-up call on the tilt table Bill Rushmore, 44, a software engineer in Pittsburgh, had his first fainting spell in his mid-20s while serving in the Navy. With unexplained fainting several times a year, he was discharged from the military and his Pennsylvania driver’s license was revoked – even though most episodes occurred while he was in bed. In November 2013, Rushmore traveled to the autonomic laboratory at Cleveland Clinic, where he underwent a tilt table test. “I ended up passing out, and they found my heart had stopped for about 38 seconds,” he says. He was immediately scheduled for pacemaker implantation for his condition, called vasovagal syncope. “Obviously, at first I was pretty frightened,” he says. “I figured life would change forever.” But when the staff showed him the result from his electrocardiogram – including the flat lining – it was hard to argue. The pacemaker is contained in his chest, up near his shoulder, and a keloid scar marks the insertion site. A monitor beside his bed automatically tests the pacemaker every so often – he doesn’t need to hook it up – and the results go directly to Cleveland. Rushmore is sleeping better and can drive again. He’s been able to resume Cross Fit workouts with minor adaptations. He’s a little bummed that he’s had to give up super- heavy weightlifting of more than 400 pounds a pop – but he’s glad to be free of heart-stopping episodes at night, and the aftermath of feeling weak, nauseous and “lousy.” Is a pacemaker right for you? In a healthy heart, electrical currents stimulate the muscle to beat properly. A normal resting rate is about 60 to 100 beats per minute, although a very fit person might have a rate in the range of 40 to 60. But when the timing of the electrical circuit isn’t working right – causing the heart to beat erratically, too slowly or too quickly – that’s when a pacemaker can help. Slow cardiac rhythm conditions are the most common reason people get pacemakers, says Daniel Cantillon, a physician who specializes in cardiac electrophysiology at the Cleveland Clinic. The sinus node, in the right upper chamber of the heart, is where normal electrical activity begins. Sinus node dysfunction (sometimes called sick sinus syndrome) is the most common reason for pacemaker implantation in the U.S. Other possible indications include heart block, atrial fibrillation, congestive heart failure and some childhood heart conditions. In tachybrady syndrome, the pulse can race up to 160 beats per minute (tachycardia), pause and drop to a much lower pace (bradycardia). Even if you have one of these diagnoses, that doesn’t necessarily mean you should have a pacemaker. “Pacing for vasovagal syncope is somewhat controversial,” Cantillon says. “Not all patients are going to benefit.” In the condition, “the brain stem sends inappropriate messages to the heart to cause it to slow down to the point where patients can actually blackout or lose consciousness,” he explains. At issue, however, is whether the primary problem is a drop in heart rate or a drop in blood pressure. A pacemaker wouldn’t help for low blood pressure. To further evaluate, you might undergo the noninvasive tilt table test. (Continued next week)