Pauses with a Pacemaker – Can You Still Get Heart Pauses with a Pacemaker/ICD?

Can a Pacemaker be set or programmed to eliminate pauses which I experience from time to time? If yes, what are the settings?
This is a questions I just received to T.H.E. P.A.D. and as promised I will attempt to answer it!
When a patient discusses pauses they continue to have despite them having a pacemaker, these always fall in to TWO categories. Either the patient is having the ‘sensation’ of pauses or the patient is having genuine pauses.
The sensation of pauses is explained in my Simplified – A Pause and a Strong Beat – Starlings Law blog post. So in this post I will address what MIGHT be happening when somebody with a pacemaker is experiencing pauses.
A Pacemakers Raison D’etre is to stop pauses, this is why they were first invented!!! If you are getting pauses with a pacemaker what the hell is going on! The most obvious answer is that something is untoward with the pacemaker. I will do a blog post on Common Pacemaker Issues when I get the chance.
There are instances where pacemakers do allow short pauses one that I can think of is when a pacemaker is programmed AAI=DDD. This is jargon for a pacemaker that just paces in the top part of the heart until it is required to pace in the bottom of the heart too. Its decision making process is based around the bottom of the heart not beating of its own accord. When this happens the pacemaker switches modes to one that is pacing in the top and bottom of the heart so this process allows and in fact requires short pauses before it commences the correct pacing mode. The pacemaker will stay in this mode and do regular checks to see if it can return to AAI Mode (Pacing the top heart only).

Why would it do this? Studies have shown that it is beneficial to somebodies health if you can reduce the pacing in the bottom chambers (the ventricles) so if you can stay in AAI (pacing the top of the heart) where and when you can it is beneficial to your health.
I have detailed one of these Top Chamber <=> Both Chamber Algorithms in my post Sorins SafeR this function can be disabled and the pacemaker set simply to DDD and this will stop these small pauses. HOWEVER this will probably increase the amount of Ventricular Pacing.

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

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