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Suggest treatment for pacemaker syndrome

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Posted on Wed, 26 Nov 2014
Question: I had a cardiac tamponade during pacemaker surgery Oct 13th, 2014. The lead for the ventricle had to be placed 8 times and on one of the times when it was moved it started a bleed. I was half awake, and advised I could not breathe and that is the last I remember. They called a code blue and put me on a ventilator and placed in ICU for 36 hours. Went home after about 48 hours. The pacemaker is working (had fast and slow problems and a heart block) and it has been almost 3 weeks but I am still so very tired. Doing ok, but I am not used to feeling this tired most of the time. I am a 64 year old female in good shape with no other heart problems. Is this normal to feel so tired?
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Answered by Dr. Tushar Kanti Biswas (1 hour later)
Brief Answer:
Pacemaker syndrome

Detailed Answer:

Thank you for your query. I can understand your concerns.
Disturbances in atrioventricular synchrony and/or left ventricular mechanical synchrony can give rise to fatigue following PPI( Permanent Pacemaker implantation).Right ventricular apical pacing can induce dyssynchronous activation of the left ventricle, leading to compromised left ventricular (LV) systolic function and consequent tiredness.Maintenance of AV synchrony can minimize the sequelae of pacemaker syndrome.







Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Tushar Kanti Biswas (3 hours later)
I am also on Metoprolol 12.5mg twice a day and have been for 14 days. I understand that this will also make me tired but that should subside soon.

How do you achieve maintenance of AV synchrony to minimize the pacemaker syndrome you discussed?

Thank you for your time, Dr. Biswas.

XXXX
doctor
Answered by Dr. Tushar Kanti Biswas (1 hour later)
Brief Answer:
Persistent tiredness & Permanent Pacemaker implant

Detailed Answer:
Hi,
I like to know five-letter code of your pacemaker. The most commonly programmed modes of implanted single- and dual-chamber pacemakers are VVIR and DDDR, respectively. The fifth refers to the existence of anti tachycardia functions if present (O, none; P, antitachycardia pacing; S, shock; D, pace + shock).
Biventricular pacing can help minimize consequences of pacing-induced mechanical dyssynchrony at the ventricular level.
For some patients who are ventricularly paced, usually the addition of an atrial lead and optimizing the AV synchrony usually resolves symptoms.
Low cardiac output gives rise to fatigue, weakness.
Metoprolol can induce hypotension but usually not at dose 12.5 mg twice a day, unless you are also on some other drug.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Follow up: Dr. Tushar Kanti Biswas (12 hours later)
Not sure where to find this 5 letter pacemaker code.

I have a Medtronic Advisa DR MRI SureScan pacemaker. Medtronic A2DR01. Dual chamber. Rates are set 60 for the low and 130 for the high. My diagnosis on my chart states Ectopic Atrial Tachycardia, Mobitz type 2 degree atrioventricular block, RBBB.

Have had the pacemaker checked 3 times since surgery as they were worried about the leads, but all seem fine.

Could having all the drugs, having the heart nearly stop and the ventilator be what is causing my fatigue?

I am only on Metoprolol and they reduced it two weeks ago because my heart rate was staying so low. I was on 25mg twice a day which is still a low dose but it was a bit much for my system.

Thank you.
doctor
Answered by Dr. Tushar Kanti Biswas (6 hours later)
Brief Answer:
Persistent weakness & cardiac resucitation

Detailed Answer:
Hi,
Your pacemaker is dual chamber and seem working fine.
Undue fatigue may be due to left ventricular dysfunction.You must have undergone 2-D Echocardiography following recovery from cardiac tamponade . Left ventricular ejection fraction(LVEF) will give clue to your cardiac output (pumping action of the heart) and diastolic dysfunction.
The effects of drugs administered during your ICU care/resuscitation are unlikely to last even after 03 weeks.
Even critical Illness Myopathy/neuropathy causing diffuse weakness is very unlikely as patients undergo complete recovery with succesful treament of the critical illness, and withdrawal of the medications.
It is the primary heart condition which is the major contributor of your persistent weakness most likely.Of course your hemoglobin status,Liver function tests are other areas of investigations.
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1910 Questions

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Suggest treatment for pacemaker syndrome

Brief Answer: Pacemaker syndrome Detailed Answer: Thank you for your query. I can understand your concerns. Disturbances in atrioventricular synchrony and/or left ventricular mechanical synchrony can give rise to fatigue following PPI( Permanent Pacemaker implantation).Right ventricular apical pacing can induce dyssynchronous activation of the left ventricle, leading to compromised left ventricular (LV) systolic function and consequent tiredness.Maintenance of AV synchrony can minimize the sequelae of pacemaker syndrome. Regards Dr. T.K. Biswas M.D. XXXXXXX