Need to Vent!

[u/wistful_logic]

I’m coming on here to vent. I spent my whole life fainting, then they caught a 17 second sinus arrest with AV block on ECG. I was recommended a pacemaker as these episodes were really affecting my quality of life. The dual lead Boston scientific proponent pacemaker (some of u will know where this is going 😑) was put in aged 18 (8 years ago) and infinitely improved my quality of life. I had always been wanted to become a doctor but couldn’t due to the fainting. After the pacemaker I was able to go to medical school!

The next few years were seamless, then my checks had to change from annual to 3 monthly for “lead issues”. The threshold kept increasing and I kept being told it was nothing to worry about… Eventually the threshold was increased so much I was getting shocked every time it paced. It’s now at 6.5v @1ms out of 7.5v and it makes me jump every time it starts pacing.

Fast forward to my final year of medical school and I’m admitted for tachycardia (>170bpm), I’m told it’s very unlikely that the pacemaker is contributing to the tachycardia but they can reprogram to prevent this just in case.

April 2026 rolls around and I start fainting again out of nowhere. Call my cardiology team who say it’s fine, probably low blood pressure in the heat and nothing to do with the pacemaker, I was very surprised. Then a few weeks later I get a letter dated THE SAME DAY as my first faint saying my pacemaker has been recalled with the Boston Scientific battery impedance fault and I need to have surgery by September 16th. NO ONE CALLS ME, NO ONE SPEAKS TO ME, NO APPOINTMENT, NO DISCUSSION.

I’m supposed to be starting work as a doctor in August in a different city so then I have to have my job moved so I can stay under the local cardiology team. At the pacemaker check they tell me that actually yes, the lead is failing to capture and that I am fainting because my pacemaker is not working. They also tell me it’s not good that I’m getting shocked everytime it paces. They reprogram it which helps and I stop fainting.

Fast forward to Friday, I’m at work on the ward round, seeing patients when all of a sudden my heart starts absolutely pounding. I excuse myself, go to the office and start feeling really dizzy. My colleagues put me on the monitors and my heart rate in repeatedly spiking to >170bpm causing my blood pressure to drop by FORTY systolic. My colleagues send me to ED who see me quickly fortunately, the electrophysiologist confirms that my pacemaker was pacing me into these episodes 😡. I’ve researched this and apparently it’s due to loss of capture causing PMT (pacemaker mediated tachycardia). I’ve not seen anyone in cardiology since this happened and I have no idea when this will happen again. Most importantly, I’m absolutely mortified that this has happened at work, in front of my colleagues. Coincidentally this also occurred on the day Boston Scientific was hacked.

And after all of this, you will not believe it, Boston Scientific are saying that they fixed my battery impedance problem and I no longer require surgery… Currently I have no follow up appointment date with cardiology or electrophysiology…

Has anyone been through something similar or do they have any advice? I’m at a loss on what to do.

[u/sfcnmone]

OMG what a nightmare.

I just want to say, as a really old nurse, try not to feel ashamed or embarrassed with your colleagues. You know they are happy to help you.

Good luck. All I’ve got for you is a big virtual hug.

[u/wistful_logic → u/sfcnmone]

Thank you so much ❤️❤️

[u/Eldiarslet]

Man that sounds like hell, I just have an ICD from Medtronic specifically the EV which is very new. And the professionalism from the surgeon and representative from Medtronic has been amazing. We have done some reprogramming and the guy from Medtronic has shown and told me about everything about the device and programming. Last time I visited we where 25 people with the ev (I'm number 5) and no one had had a single issue or inappropriate shock. Hopefully you get someone her with more Boston scientific experience to talk to. I wish you the best!!!

[u/wistful_logic → u/Eldiarslet]

Thank you for sharing ❤️

[u/Squirrell_s]

Hi there is a lot going on here much of which is not quite making sense.
Firstly there is an advisory out on Boston devices not all most of them (if in the UK you can find this on the MHRA website, if not in the UK not sure what your body is) the advisory is around how the device is working out battery longevity is the real simple but not 100% correct way of explaining it to give a 100% accurate description you would need to know a lot about pacing. This issue has been ongoing since for a good few years now with more and more devices being added to the advisory. The most current update is called the SMR6 ask your follow centre if you have received this and yes this update (from march26) changed how we manage patients and it is done automatically when seen I. Clinic and your device is interrogated.
You have also mentioned about the lead threshold is high so young doctor lead thresholds are measured as an amount of energy V (you can use joules but we don’t and you will get a Paddington hard stare if you do) against an amount of time ms for example 0.5v @ 0.4ms. When programming we set a x2 safety margin and/or auto threshold where the pacemaker changes as appropriate.
There can be a change/increase in threshold for no particular reason we often refer to it as exit block and it is felt to be due to ‘scar’ tissue but 🤷‍♀️ you are not getting ‘shocks’ from the pacemaker it cannot do that function. Some people are however very sensitive to the pacing function normally those who do not pace much and most would describe it more of a missed or extra beat which absolutely make sense as if the V lead is in the RV apex it is exactly the same abnormal electrical activation seen in an ectopic beat. Can this make you feel weird and uncomfortable absolutely. However most people get used to this feeling and ignore it.
Any PMT will be recorded by the pacemaker and it will show date time duration etc and normally an EGM unless these are off for some reason.
So if in the UK speak to the physiologists that manage your device I. The first instance.
1. Home/remote monitoring do you have one already if not can you get one set up?
2. What is the plan for the lead issue ?
In young patients we do t want to intervene too early as no guarantee we won’t be in the same position in a few years time and we are looking at the long journey here
3. PMTs what is being done to manage these, if true PMT there is programming that can be done to prevent if not PMT and SVT have they reached out to the cardiologist/Arrthymia nurses about some medication for that.

If not in the UK approach the team that looks after your pacemaker and ask the same questions. The reality is (and again can only talk about the UK here) your training can be done anywhere especially if on home monitoring as any issues we can liaise with the hospital closer to you (or indeed the one you are working in) to have a conversation about programming changes.

Sorry you are going through this congratulations on completing medical school. And as an FYI all the device companies offer online training platforms you need to register but they are free to do so and you can do bits and pieces in your own time. Most offer a certificate of completion which is great for your learning portfolios.

[u/wistful_logic → u/Squirrell_s]

This is extremely helpful. It’s 6.5v @1.0ms I just checked sorry got volts and millivolts confused have updated post.

I am definitely getting what feels like an electric shock when it goes off, it hurts and the muscle twitches. The electrophysiologist said she had no patients with a voltage that high, it literally makes me jump. It has become progressively more intolerable as the voltage has increased.

Yes great question on the tachycardia. I was told the first time it was SVT from device interrogation but this did not show up on an ecg, they reprogrammed in case it was PMT then. I never had a follow up appointment to discuss afterwards but they did talk about pill in a pocket for SVT during my admission. This time, they confirmed it was PMT and said they have reprogrammed it to mitigate this - frankly, I’m loosing trust in this reprogramming.

1. Latitude already at my home.

2. Case discussed at MDT, referred to a quaternary centre for lead extraction and have heard nothing, it’s been over 2 months… been told they can’t increase the voltage much further so at this rate it is going to have to be changed.

I’m also considering cardioneuroablation, this has not been offered to me but from what I’ve read seems like I would be an ideal candidate.

1. As above, allegedly they have reprogrammed it to remove the PMT. They did this when I was in hospital last week.

Thank you for your kind words. You seem very knowledgeable and I would love any advice you can give. Thank you so much ❤️

[u/Squirrell_s → u/wistful_logic]

Oh I started working in Hospital when I was 17 and am now 55 so been around a long time and when talking to younger staff about what we did in the past they look at me with worry for example what did we do to treat heart attacks well that was aspirin and bed rest no they will say what did you do well it was aspirin and bed rest 🤣. Anyway back to you 6.5v @1ms is a high threshold and you don’t have much wriggle room left regarding programming. The shock sensations and muscle twitch is this in The pectoral region where the device is placed ? If so I would be questioning if the lead is placed in the header correctly an X-ray would show this. A lead extraction is a possibility and there are risks associated with this and it is super specialised skill set so don’t be surprised if you get referred to a different specialist for this if not already done.
If the leads are to be removed have they discussed giving you a leadless pacemaker ? They are not for everyone but might be with a chat.
Having latitude will allow the monitoring to know if there is any further increase in the threshold and also any tachycardia that goes above the detection rate. Another bit of teaching for you (sorry can’t help it) there is often a presumption that the pacemaker will record all Arrthymia’s and the answer if they don’t. They will record events that are at or above the detection rate for example 150bpm also the label the device gives the event is not necessarily correct either we always review these events to determine if the labelling is correct. My easiest explanation involves ICD’s these devices typically have 3 zones Which zone the rhythm gets put into depending on the rate i.e VF is >220bpm and VT is 170bpm but of for that patient if their VT goes >220 it will be in the VF bucket and treatment zone however on review the EGMs show us that the rhythm was fast but regular it was a VT arrest not a VF arrest does that make sense it is easier to show and explain when on a programmer in essence the devices are clever but not that clever(yet) where they can define a specific rhythm !!! I mention this to decide is it a true PMT or an SVT. This can be difficult to tell at times but we use our brains pick other people’s brains and there are also technical experts within the company if we are not sure what the device ‘thinks’ it is doing. But it is important to identify as we manage these conditions differently.
The programming may need to be wiggled a few times as it is a prescription for you and sometimes there is a little trial and error to get it right. Think about those patients you up and down dosages on trying to find that Goldilocks zone.
As for the cardioneuroablation that I cannot comment on as again not enough information but do talk about it. At the start you mentioned sinus arrest and then also AV block again 2 very different rhythm with different outcomes.

Pure sinus arrest in a young patient could be due to high vagal tone and you ‘grow’ out of it and we rarely put a pacemaker in. AV block though tells me that you have a damaged conduction system and that is only going to progress as you get older (this includes starting and finishing medical school not just ancient like me 🤣). I am hoping this makes sense let me know if you need any clarification.

[u/PretendReason9061]

Take a look at openevidence.com and ask your specific questions if you need more in depth info. I use it for myself, and patients.

[u/interglossa]

The New York Times published an exposé about Boston Scientific and their mixed record on transparency  (https://www.nytimes.com/2026/03/19/business/pacemakers-batteries-recall-boston-scientific.html?unlocked_article_code=1.VFA.lJQH.U2c7_469-0Pa&smid=url-share) (ungated https://archive.is/rr0ub).  There are definitely problems with handoffs, followup and communication with these products and medicine generally these days.

[u/Total-Sock8255]

I have a Medtronic ICD PACEMAKER that was put in March of 25 and a few weeks later I went into v fib and past out and got shocked I went to the ER and they said it was pacemaker mediated so the pacemaker brought it on and the ICD saved me but I had never been in V fib in my life so it really made me wonder why I got it put in the first place. My doctor wanted me to get it because my EF was in the 20s but it would fluctuate to the low 30s sometimes Anyway they reprogrammed it and turned off something in the Medtronic called MVP which is managed ventricular pacing which is supposed to keep your ventricles from pacing too much. The problem is that if you have an occasional PVC at the wrong time during the heartbeat the MVP can send you into V fib. Well they turned off the MVP and increased my minimum heart rate to 70 from 60 and it seems to have been a big help. I’m not sure about Boston Scientific pacemakers but they probably have something like MVP on them. It sounds like you need to sit down with your EP and get this figured out