I have a VDD pacemaker and I pace less than 3% with low heart rate. Do I need replacement?

Question

Hello doctor,

I have been implanted with a VDD pacemaker due to Brady-tachy syndrome for ten years. My condition improved, and medication was stopped (Amiadorone and Metoprolol). I pace less than 3 % when interrogated. Now the battery is depleting, and my doctor said I need a replacement even though it is not used. My question is, can the expired pacemaker be left in your body without any problem? Can it stay useless? My big problem is a fast heart rate, not a slow one. My fainting episodes were, I think, due to hypoglycemia and not bradycardia. The lowest heart rate was 44 bpm at the time of implant. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thanks for the query. What is your age?

Answer 2

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Welcome back to icliniq.com.

How was Tachy-brady syndrome diagnosed? On Holter monitoring?
What was the rhythm of tachycardia? And what was in bradycardia?
Sinus node dysfunction rarely occurs at a young age. Can you share the Holter report?

Thank you.

Answer 3

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Holter, before some years, was normal(attachment removed for patient's identity protection) . Even that was not abnormal. A heart rate of 44 bpm is not abnormal in sleep. If you are only on 3 % (as you said) pacing, the pacemaker is not justified. The techy-Brady syndrome usually occurs in an old age patient who has atrial fibrillation as tachycardia and sinus bradycardia as Brady. In that case, rate-lowering medicines are required in tachycardia, but it causes further slowing of heart rate at times of bradycardia. So a pacemaker will work at that time.

Thank you.

Answer 4

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Were you taking any heart slowing medications during pacemaker, beta-blockers, or anything else?

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Answer 5

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During these seven years, did you have any tachycardia? What does the latest pacemaker interrogation report say?

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Answer 6

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So, the first time diagnosis of Tachy-Brady syndrome may have wrongly been diagnosed, or there might be a reversible cause of Tachy-Brady. Since only 3 % need for pacing is very low, I think there is no more need for a pacemaker. So these Premature ventricular contractions (PVCs) runs are controlled without any medicines?

Thank you.

Answer 7

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Welcome back to icliniq.com.

It can stay in the body and cause no problems. Some problems that can arise include any time you need an MRI (magnetic resonance imaging). It will not be possible because of the pacemaker. So MRI will be contraindicated. It is metal, so anytime you walk through metal detector gates, these will buzz due to the metal. If any time in your life, you develop infective endocarditis (infection of heart valves), then the whole hardware will be removed, and then antibiotics will be started according to antibiotic susceptibility. It will be better to have a new Holter monitoring done to detect the burden of PVCs. If there is a high burden of PVCs, then the ventricular function may be compromised over time. To prevent that, beta-blockers are used. Beta-blockers slow the heart rate. If beta-blockers are indicated, I would suggest having a trial of beta-blockers before removing the pacemaker. If the heart rate falls below 40 on a low dose, then a pacemaker may be needed. Second, have echocardiography done, if not done in the previous year, to see the heart's ejection fraction? If it is normal, then the pacemaker may be removed. If it is lower, then better not to remove it.

Thank you.

Answer 8

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If you develop an infection in the pacemaker pocket in the chest wall, it may extend inside the heart as leads are placed inside the heart.

Thank you.

Answer 9

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Welcome back to icliniq.com.

You were diagnosed with Tachy-Brady syndrome ten years, but your Holter did not support Tachy-Brady. Again you had Holter in two years. That was normal. Moreover, the pacing is only 3 %. And you are not taking any medicine for tachycardia, which means there is no tachycardia. So based on all this evidence, it seems that most probably your diagnosis was wrongly made. So I do not think you need any pacemakers. The only thing is that you have premature ventricular contractions (PVCs). I do not know what is the burden of PVCs in 24 hours. If the burden is high, this may lead to left ventricular dysfunction over months to years. In case of LV dysfunction, an ICD device is needed. So please have an echocardiography and a Holter done to see the PVC burden. If PVCs are low and do not have PVCs symptoms, and your echocardiography is normal, then the whole hardware can be removed. And yes, there is no emergency.

Thank you.

Answer 10

Hello,

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You are welcome. Keep in touch for further doubts.

Answer 11

Hi,

Welcome back to icliniq.com.

If there is no near future need for a pacemaker, leads can be removed. If kept in place, then still no issue.

Thank you.

Answer 12

Hi,

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The Site seems good (attachment removed for patient's identity protection). You can wash it with water and soap but make it dry afterward. The hole is not visible here. If there is a wound, it will heal. But if there is a clear hole, then it may need to be sutured.

Thank you.