Can You Have Heart Palpitations With A Pacemaker?

As you might surmise from their name, pacemakers are all about regulating pace, namely, the pace of your heartbeats or the contractions of your heart’s chambers.

Can You Have Heart Palpitations With A Pacemaker

So, the idea that those fitted with a pacemaker having heart palpitations sounds counterintuitive.

However, the truth of the matter is that you can indeed have heart palpitations with a pacemaker.

In fact, sometimes, it’s the pacemakers themselves causing the problem, but even if your pacemaker is working exactly as it should, you may still experience palpitations of some description.

Let’s take a closer look at why.

Why Pacemakers Don’t Always Alleviate Heart Palpitations

The important thing to know about heart palpitations is that they are a perceived alteration in the rhythm of your heartbeat, which is to say that what you feel as though your heart is doing doesn’t necessarily correlate with what it’s actually doing.

It’s a pacemaker’s job to regulate your cardiac rhythms, but if you’re only perceiving the palpitation rather than actually experiencing a change in rhythm, as far as the pacemaker knows, everything is a-okay — 9 times out of 10, it is.

In other words, palpitations are more often than not a psychological phenomenon rather than physical, and pacemakers handle the physical side of your heart rhythms.

But what if the strange cardiac rhythms aren’t in your head?

Well, if you are feeling a pounding in your chest indicative of an irregular heartbeat, your pacemaker should be able to help straighten things out again.

There’s also a chance that the peace of mind a pacemaker provides will ease the psychological element at play, reducing the frequency and intensity of palpitations.

Do Pacemakers Trigger Heart Palpitations?

While it’s not incredibly common, studies have indeed shown that pacemakers can initiate or exacerbate various forms of arrhythmia, symptoms of which may include palpitations.

The form of arrhythmia varies in accordance with the location and function of the pacemaker but in most cases, it’s possible that the patient will experience palpitations.

The different forms of pacemaker-mediated arrhythmia are as follows:

  • Reentrant tachycardias (antidromic)
  • Reentrant tachycardias (orthodromic)
  • Repetitive nonreentrant ventriculo-atrial synchrony
  • Tracking of supraventricular arrhythmias, electromagnetic interference, lead noise, or myopotentials
  • Sensor-driven tachycardia
  • Runaway pacemaker
  • Pacemaker-mediated arrhythmias in cardiac resynchronization therapy systems
  • Pacing-induced atrial/ventricular arrhythmias

The majority of these arrhythmias are triggered by a misreading of the natural efforts of the heart to regulate itself, but some are purely technical issues rather than a mix of technological and biological.

For instance, runaway pacemaker is the result of failing pacemaker batteries, software errors, or some form of electrical damage to the unit.

Thankfully, though, modern pacemakers rarely reach this stage of malfunction.

What Should I Do If I Have A Pacemaker And I’m Having Heart Palpitations?

Can You Have Heart Palpitations With A Pacemaker

While it’s true that it might not actually be your pacemaker triggering or sustaining your palpitations, it’s essential that you report these events to your doctor.

When left unchecked, a problematic pacemaker can accelerate cardiac deterioration, so the earlier the issues are addressed, the safer you’ll be.

There has been enough research in this area that your doctor should be aware of all the potential pacemaker pitfalls, but it doesn’t hurt to clue yourself up on the various arrhythmias too, just to be safe.

Can A Problem Pacemaker Be Fixed?

Finally some good news for you! No matter which form of pacemaker-mediated arrhythmia you’re experiencing, it can be resolved by tweaking the functionality of the pacemaker.

As there are so many potential arrhythmias, identification can be tricky, but with proper testing, it’s usually a relatively efficient process.

Once the problem is isolated, your doctors will then be able to amend the pacemaker’s performance to suit your natural biology.

There is, however, one instance when you may have to have your pacemaker completely switched out, and that’s when it’s malfunctioning with a case of runaway pacemaker.

Most of the time, this means that your pacemaker is on its way out and will need to be recovered either to be fixed or retired.

If you’re simply experiencing a continuation of the same type of palpitations you were before the fitting of your pacemaker, there’s very little chance that the pacemaker has anything to do with them.

It’s still worth getting yourself checked out, but the real cause for concern occurs when you’re experiencing new or extended forms of palpitations.

And by “new”, I mean that they feel different or occur during different times/activities/emotional states.

Developments in your palpitations should always, always be reported to a doctor, but this is particularly important when it comes to those with pacemakers.

Will My Pacemaker Need To Be Removed To Be Adjusted?

I’ve more good news for you — Hooray!

If it turns out that it is your pacemaker causing or exacerbating your heart palpitations, (see also: Can Constipation Cause Heart Palpitations?)you won’t need to have your implant removed, with the exception of a runaway pacemaker scenario.

Pacemaker functionality can be amended using a PRM (programmer/recorder/monitor).

PRMs are external computerized devices that link up to your pacemaker via radio waves emitted by a specialized wand positioned above the implant site.

You can think of PRMs as pacemaker remote controls, but they’re not just for adjusting pacemakers, but monitoring them as well, hence the “recorder/monitor” thirds of their name.

A doctor will use a PRM to record the performance of a pacemaker, all while monitoring your vitals.

They’ll be looking for specific signs that point them in the right direction regarding a diagnosis. For example, a narrow QRS clearly indicates orthodromic PMT as opposed to the many other possibilities.

Side note — For the uninitiated, QRS refers to the three primary graphical deflections displayed on an EKG machine. You know when the machine beeps, and you see a spike on the graph representing a heartbeat? Well, that’s the QRS.

Final Thoughts

While a pacemaker can in certain instances reduce the frequency and intensity of heart palpitations, as palpitations are primarily psychological in nature, it’s likely that an implant will have no beneficial impact in this regard.

Unfortunately, negative impacts are more prevalent, with studies showing that there are a number of ways in which pacemakers can trigger or extend arrhythmias, which, by extension, can increase the chances of a patient experiencing palpitations. 

Clare McAfee
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