Heart palpitations—the feeling of a skipped, fluttering, or pounding heartbeat—are often the symptom a person hopes to resolve by getting a pacemaker. Experiencing this sensation after receiving a device designed to stabilize heart rhythm can be confusing and alarming. While the pacemaker regulates the heart’s electrical system, patients commonly report new or persistent palpitations in the days, weeks, or months following the implant procedure. Understanding the reasons behind these sensations, which range from temporary bodily adjustments to technical device interactions, provides necessary context and a path toward resolution.
Temporary Causes Related to Surgery and Healing
The physical act of implanting a pacemaker involves placing the device generator and threading thin wires, known as leads, into the heart chambers. This minor surgical procedure naturally causes localized trauma and inflammation. The resulting irritation in the heart muscle where the lead tip is newly lodged can temporarily increase the heart’s electrical excitability.
This irritation can trigger premature beats, such as Premature Ventricular Contractions (PVCs), often felt as a distinct “skipped” or “hard” beat. These palpitations are usually transient, subsiding as the tissue heals and a stable layer of scar tissue forms around the lead tip, typically within the first six weeks. Stress surrounding the surgery can also elevate circulating adrenaline, contributing to a temporary increase in heart rate.
Technical Issues with Pacing Settings or Lead Placement
Palpitations may signal a problem with the device’s hardware or its initial programming. One time-sensitive issue is lead movement, or micro-dislodgement, which is most likely to occur within the first six weeks post-procedure. If a lead shifts slightly, electrical contact with the heart muscle can become unstable, leading to a failure to capture the heart’s beat when the pacemaker fires.
Sensing Issues
The device may struggle with sensing the heart’s natural rhythm, a common cause of palpitations. Undersensing occurs when the pacemaker fails to detect a natural heartbeat, causing it to fire an unnecessary electrical impulse and resulting in an extra beat. Conversely, oversensing happens when the device mistakenly interprets non-cardiac electrical signals as a natural beat. This suppresses pacing, which can lead to a pause or a skipped beat sensation.
Rate Programming
The programmed rate can also contribute to discomfort if initial settings are not optimal. If the programmed lower rate is too high or too low, the patient might feel their heart racing or beating sluggishly. Technicians often need to make several adjustments to the rate and sensitivity settings in the weeks following implantation to synchronize the device with the body’s needs.
Conditions Caused by Pacing Patterns
Specific rhythm interactions caused by the pacing pattern can lead to palpable discomfort. One well-documented phenomenon is Pacemaker Syndrome, which typically occurs in patients with single-chamber ventricular pacemakers. This condition arises from the loss of natural synchronization between the upper (atrial) and lower (ventricular) chambers of the heart.
When the ventricle is paced before the atrium contracts, blood can be forced backward, leading to symptoms that include a pounding sensation in the neck, fatigue, and palpitations. Another condition is Pacemaker-Mediated Tachycardia (PMT), an “endless loop” of rapid heartbeats that occurs with dual-chamber pacemakers.
A ventricular paced beat can sometimes conduct backward to the atrium, which the pacemaker incorrectly interprets as a signal to fire another ventricular beat, perpetuating a rapid cycle felt as a racing heart. These specific syndromes often require device reprogramming, such as adjusting the post-ventricular atrial refractory period (PVARP) to break the tachycardia loop or switching pacing modes.
Warning Signs and When to Seek Medical Help
While many post-implantation palpitations are benign and temporary, certain accompanying symptoms suggest a potentially serious issue requiring immediate medical evaluation.
You should contact your cardiology team or seek emergency services if palpitations are associated with any of the following warning signs:
- Chest pain or pressure.
- Sudden or severe shortness of breath.
- Significant dizziness or fainting (syncope).
- A sudden return of the symptoms the pacemaker was implanted to treat, such as extreme fatigue or a very slow heart rate.
- Signs of infection at the implant site, including increasing redness, swelling, warmth, or discharge.
- A persistent fever.
These symptoms suggest the heart rhythm is severely compromised or indicate an infection. Though device malfunction is rare, any symptom that feels dramatically worse or is new and persistent should be reported to ensure timely device interrogation and necessary adjustments.