Can You Have Heart Palpitations With A Pacemaker?

According to the World Heart Federation, cardiovascular deaths have increased by more than half in the last 3 decades. Heart disease is the number one cause of mortality in the US . There are many treatments and various outcomes. One of the treatments used for certain heart diseases is the implantation of a pacemaker. In this article, we will explore the question of whether heart palpitations can occur despite the presence of this device. We will review the role of a pacemaker in regulating abnormal heart rhythms and discuss the risks associated with pacemaker implantation.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can You Have Heart Palpitations With A Pacemaker?

Yes, even in the case of having a pacemaker, it is possible to experience heart palpitations. Presence of heart palpitations can be a symptom of pacemaker syndrome. This is a syndrome of new or worsening symptoms after the pacing the heart rate. This syndrome occurs in approximately 15% of patients with ventricular pacing [3] and is linked with a lack of coordination between the upper and lower heart chambers. In some cases of heart palpitations, pacemakers can be directly involved in initiating arrhythmia [4].

Heart palpitations have different causes. For example, Heart palpitations can be caused by stomach gas, or periods. Additionally, certain medications like Xanax or Ativan can cause or help heart palpitations.

What is a pacemaker?

A pacemaker is a small electric medical device that is implanted under the skin to help manage irregular heart rhythms (arrhythmias) [5]. This device is used in cases when the heart fails to propagate or to generate efficient electrical pulses [6]. Thanks to the stimulation, the heart can sustain a beat sufficiently to fulfill the demand for blood [7]. It works by sending local low-energy electrical impulses to the heart. The frequency, which is called the pacing rate, is programmable. The pacemaker can use the sensor to sense the heartbeat and turn on automatically to bring the heart rate to normal when needed or it can beat without a break [8].

This small helping device is used to treat many different heart conditions. They are used in too-fast heart rates (tachycardias) or too-slow beats (bradycardias) [9].

Modern pacemakers have two parts: the pulse generator, which contains the pacemaker’s battery and the electronics that generate electrical pulses. Additionally, there are one or more leads which are linked to the devices via thin wires. They are placed in the heart muscle and through them, the electric shocks are delivered [5].

When is a pacemaker used?

Pacemakers are primarily used to treat a variety of heart rhythm irregularities or arrhythmias, most commonly bradyarrhythmia [6]. They are also used in the management of atrial fibrillation [10]. The atria are the upper chambers of the heart. When they fibrillate, many small sources of electrical activity arise in an uncontrolled manner. In such situation, the electrical pulses travel down to the lower heart chambers (ventricles) irregularly and often rapidly. When a pacing device is implanted, the connection between the upper and lower chambers of the heart is severed by ablation. Afterwards, the ventricle no longer depend on the chaotic atrial fibrillation and beat in a regular-paced manner. They can effectively pump the blood because it fills them passively. Pacemakers are also used to treat conditions with bradyarrhythmia. They offer relief for patients with conduction system blocks, such as advanced heart block, sick sinus syndrome, or bundle branch block [11]. In cases of heart surgery or heart attacks when the heart needs only short-term pacing support, temporary pacemakers are used. In all other cases, the devices are implanted permanently [7].

What are the risks of a pacemaker?

Pacemaker implantation is generally considered a safe procedure. However, it does carry some risks, mostly associated with the implantation process itself. An example is the allergic reaction to anesthesia used during the procedure [5]. Bleeding or bruising at the site of the incision is another common risk, as is the clotting risk [5, 8]. During the procedure, damage to nerves or blood vessels is also a possibility [5]. Additionally, an infection at the site of the incision or of the leads themselves can occur. When it comes to the pacemaker, a risk of dissociation between the pacing and the cardiac cycle exists. This situation is referred to as pacemaker syndrome. Its symptoms are fatigue, dyspnea (shortness of breath), and hypotension (low blood pressure) [5, 8]. Because the implantation happens in the chest, lungs can collapse during the procedure, leading to pneumothorax [5, 8]. It is rare, however, that the leads of the pacemaker can puncture the heart [5]. A logical and functional risk of electric pacing devices is that they can malfunction. Common problems are lead misplacement, insufficient battery level, as well as programming errors [5, 8].

How long can a person with a pacemaker live?

Life expectancy in patients with pacemakers depends on factors like the reason for implantation, overall health status, age, and gender. A study by O. Fiandra et al. looked at ten patients with pacemakers, who had survived to be 100 years of age or more. The average time they lived with a pacemaker was 11.4 years [12]. This shows that it is possible to live long also with an artificial source of heartbeat. Another study by J. Kyle et al. followed more than 350 patients for 15 years. They reported a five-year survival rate of 58% and a ten-year survival rate of 38% [13]. That would indicate that the study of O. Fiandra et al. could have found especially long-living people as the 10 of them had lived for more than ten years.

A recurring problem of an implanted pacemaker is the battery change. On average, the electric source holds for 8 years. After that time, a replacement is needed. This could pose a risk to people who are older and, by nature, more fragile, so-called nonagenarians. A study by Aurélie Loirat et al. looked at this problem, and they concluded that this procedure is safe. They reported survival rates after pacemaker replacement were 84.2% at 1 year, 66.9% at 2 years, and 22.7% at 5 years [14]. However, the proportion of patients expected to undergo a device replacement due to battery depletion is reported to be twice as high in those aged less than 70 than in those older [15].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.