Patient: I had a two-chamber pacemaker implanted two weeks ago, but I still have an irregular heart rhythm, sometimes fast, sometimes slow, sometimes just over 40 beats per minute, often with pauses. Is it possible that the pacemaker is not working? Should I go to the hospital where the surgery was performed and have it checked again? What should I do if my heart rate is still irregular? Wang Jing, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing
Wang Jing, Department of Cardiovascular Medicine, Beijing Fu Wai Hospital: The pacemaker only works when the heart rate is lower than the set value, but not when the heart rate is faster than the set value, so if you have arrhythmias such as premature beats, atrial tachycardia, atrial fibrillation, etc., you will still have arrhythmias because the pacemaker does not care about “fast” but “slow”. The pacemaker does not care about “fast” but only about “slow”. With “40+ beats per minute” you must be counting the pulse and not the heartbeat, which is lower than the heartbeat when you have premature beats or atrial fibrillation. If you are worried that the pacemaker is not working, memorize a Holter and ask your doctor for clarification. Also you’ll know what the arrhythmia is, and oral medication will do the trick.