2:1 Heart Block, 3.3% Pacing – Do I need my Pacemaker?

2:1 Heart Block, 3.3% Pacing – Did I need my Pacemaker?

Readers Questions
I just had my semi-annual pacemaker checkup. I was told that my Medtronic pacemaker is pacing me just 3.3% of the time. I feel well, am running 5 to 6 miles every other day and also cycle regularly. My question is did I really need a pacemaker if it’s only used very infrequently? Could my underlying condition have improved since implantation? I was diagnosed with AV block Mobitz type 2 in January this year. No plumbing problems, heart rate increases normally with exercise. I had pauses up to 7 seconds at night (based on 24 hour holter monitor). Current settings are min rate 60 (50 at night), max 150. Rate response off.

Firstly, thank you for your question, its a good question and I am sure many other people are in the same boat!
As a pacemaker technician and not a Doctor I would be unable to answer whether or not your underlying condition could have improved, though it is not something I have personally come across in my working career to date. I am also unable to give you any medical advice or indeed speculate whether your pacemaker implant was appropriate or not..
I do know that our doctors at my practice consider every option before pacemaker implantation especially in the younger generation where they will then require multiple devices in their lifetime. 
Pacemakers work as much or as little as they are required to… 
A bit about intermittent conditions such as intermittent 2:1 HB.
In intermittent conditions (ones that come and go) it is not uncommon for pacemakers to have to kick in only briefly however the importance of the brief intervention is often paramount. If a pacemaker has just paced 3.3% of the time over 6 months it may seem almost negligible However if you look at those figures slightly differently then it can sound a lot more substantial. If we we consider there is 730 hours in the month then 3.3% of this is 24 hours (almost conveniently) so over every month the pacemaker is required to work for an entire day (cumulative).
Alternatively you could think of it as an average of 48 minutes each day.
Depending on how symptomatic a patient is, just a few beats of 2:1 Heart Block or other intermittent heart blocks, could cause dizziness or fainting… which could lead to injury to themselves or others.
Without seeing your file I could not say anything without any certainty but doctors are trained and will make the best decision based on the information they have. The ideal scenario is a patient who lives a totally normal life and who uses the pacemaker as little as possible. 

When a patient feels so well that they question whether they even needed the pacemaker in the first place, I see that as a credit to their cardiology team and pacemaker staff.

If you do have any concerns over the reasoning/rationale behind your pacemaker and indeed how often it is working then I suggest you contact your Cardiologist and your pacemaker team, they will be able to answer your questions directly.

A complete explanation of these topics and more is available in the book Pacemakers Made Easy by Carl Robinson.

Thanks for reading,

Cardiac Technician

Time for Football Training!

Image courtesy of jscreationzs / FreeDigitalPhotos.net

Comments 5

  1. I am 100% paced. AV Node ablation and heart block/bundle if His. HCM w/PAH. PM changed to ICD. Exercise intolerant..rate response is on.

  2. As a pacemaker rep, I have seen several people with similar pacing percentages (<5%) and the same question, "Did I really need the procedure?" Remember, although you only paced 3.3%, what would your heart rate have been without the pacemaker and more importantly when or what activity would you be performing?
    No pacemaker can or ever will be able to tell you what your heart rate would have been if it did not pace. If your heart has a 7 second pause in bed, not a huge problem, however if you're running, driving or working, that might be a huge problem. Relax, knowing that you will never have to worry about a pause during critical activity.
    Based on your stated medical history, you almost certainly need the pacemaker, and chances are that as you age, your pacing percentage will increase.

  3. I also have the same issue Mobitz Type II and also have a pacemaker that from the very beginning I questioned do I need this? For me I was very lucky as this question was answered for me just before the ‘installation’ operation. At 33 and having just been on the podium for a 10 hour Endurance Mountain Bike race being told I needed a pacemaker was not expected or wanted… my life would change.
    Whilst waiting to go into the operating theater I started to feel faint (fairly normal for me in life at the time) so called out…. The next thing I was waking up with wires attached to all over my body, two big stickers on my chest, someone taking a big tube out of my mouth and to top it off a man on top of me and pushing me into the bed. At the time I thought wow they take this fainting thing seriously here, they need to chill out. More importantly I wondered where all these people came from as the room was very busy and when I called out it was all fairly quiet.
    Today? Well at 36 nothing much has changed apart from the races. In the summer it was back on the podium, another Endurance Mountain Bike event but this time 24 hours (with my partner) The pacemaker? Yes that’s been ‘in there’ for coming up 3 years now and the pacing? Well that’s now down to 0.1% (It started in the 50% range in 2010)
    Do I still need a pacemaker? Yes because your only one “faint” away from not waking up.

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