ECG and other methods for diagnosing supraventricular pacemaker migration

Pacemaker migration is a process in which the source of impulse intended to create a heartbeat is located elsewhere. Under normal conditions, this impulse occurs in the sinus node, which is located at the top of the right atrium, but if the impulse is created in other areas of the heart, then the person has had a pacemaker migration. This feature can signal serious diseases of the cardiovascular system. If a person finds that the pacemaker is located in the wrong place, you should visit a cardiologist or arrhythmologist for diagnosis and treatment.

Reasons for the development of pacemaker migration

In the heart of a healthy person, the number of impulses on which the cardiac cycle of contractions depends is regulated by pacemaker cells. These cells are located in all parts of the myocardium, and the multilevel process contributes to maintaining a normal rhythm even when the functioning of the systems deteriorates, for example, due to illness. Migration of the supraventricular pacemaker is characterized by a gradual shift of pacemaker cells from the sinus to the atrioventricular node. This happens in a child when he has neurovegetative dysfunction. Adults can survive it because of ischemia.

In most cases, the migration of the pacemaker is the result of some disease. Such a deviation is diagnosed in many cardiovascular pathologies.

1. SSS (sick sinus syndrome). The essence of this pathology is that the sinus node creates insufficiently strong and infrequent impulses, which is why they are forced to form in other places.
2. Ischemia. Atherosclerosis of the coronary vessels and veins provokes coronary heart disease. With such a violation, the heart does not have enough oxygen, and because of this, the myocardium is in a stressful state. As a result, the heart rhythm goes astray and migration of the pacemaker is possible.
3. Defect of the tricuspid valve (or mitral). These valves are located between the atrium and the ventricle, and if their structure or work is disturbed for stable pumping of blood, the atria function more actively than usual. All this overloads the atria, and they, often unable to withstand the load, fail in the form of a change in the location of the pacemaker.
4. Inflammation of the heart muscle. The inflamed myocardium often causes abnormal heart rhythms.
5. VSD of hypotonic or mixed type. Vegetovascular dystonia of this nature increases the tone of the vagus nerve, which causes problems associated with heart rhythm.

In some cases, the deviation in question is also detected in people without any problems with the cardiovascular system. Then the migration of the pacemaker is considered a special property of a person and is not amenable to therapy.

Possible manifestations of pathology

Symptoms of this deviation depend on the disease that caused the migration of the pacemaker.

1. Vegetovascular dystonia of the hypotonic type. With this disease, there is a rare pulse, low blood pressure, increased sweating, cold and excessive release of moisture in the limbs, as well as increased salivation.
2. SSSU. This syndrome is characterized by frequent migraines, dizziness, rapid loss of strength, slower heartbeat, memory impairment, irascibility, changeable mood, chest pain, myocardial inconstancy, its temporary stops and shortness of breath.
3. Ischemia. This heart disease causes pain in the chest, which often has a pressing or burning character. These pains are given in the left arm, shoulder joint or jaw.
4. Inflammation of the myocardium. This process is accompanied by heart pains that suddenly begin and also end abruptly. In addition, there are failures in the contraction of the heart muscle, which causes dizziness and a feeling of unstable heart function. The patient also has breathing problems and swelling.
5. mitral stenosis. Such a heart disease is accompanied by swelling of the limbs and abdomen, unstable breathing, hoarseness, hepatomegaly, and pain in the heart area.
6. mitral insufficiency. The patient begins to cough, breathe unsteadily, feels discomfort and pain attacks in the area under the right ribs. There may be swelling and pain in the heart, which has a aching character.
7. Tricuspid stenosis. Due to the narrowing of the opening between the right atrium and the ventricle, a person constantly feels weakness, tachycardia, pain in the stomach area and under the right ribs. The patient often feels sick, has belching after eating, low blood pressure, bluish mucous membranes, and yellow skin. Also, a person may experience an unreasonable cough.
8. Tricuspid insufficiency. Because of this pathology, the patient's heart rate increases, the heart often seems to jump out of the chest, and bouts of dizziness sometimes even reach loss of consciousness. The patient's face often swells, the liver becomes larger than normal size, heaviness occurs under the right ribs, the patient feels sick, vomits. A person constantly feels weak and experiences bouts of coughing, up to hemoptysis.

Often, pacemaker migration is first noticed on an ECG. An electrocardiogram can show some features that are characteristic of the pathology in question.

• each contraction of the heart changes the shape and polarity of the P wave;
• sometimes the P-Q interval changes its duration;
• the P–P interval lasts for different times.

Diagnosis of the considered deviation

Such a diagnosis can be made using a combination of diagnostic procedures.

1. History of illness and complaints. The doctor analyzes the information received from the patient, is interested in whether the heart is stable, whether the patient experiences weakness, whether there is a loss of working capacity, whether there is discomfort or pain in the cardiac region. If a person has any of the listed manifestations, then the causes of their occurrence should be determined.
2. Anamnesis of life. Analysis of data on chronic diseases, surgeries and injuries will help in making a diagnosis.
3. Family history. The presence of diseases of the cardiovascular system in relatives ranks a person in certain risk groups.
4. Physical examination. The doctor examines the patient to determine the color of the skin, its general condition, as well as the condition of the hair and nails, the respiratory rate is analyzed, and it is checked whether there are murmurs or wheezing in the heart.
5. General examination of blood and urine. These basic tests provide general information about the state of the body.
6. Biochemical study of blood. With its help, the level of total cholesterol (from which, in fact, the cells of the body are built), low-density cholesterol (due to which cholesterol plaques occur), high-density cholesterol (which prevents the formation of cholesterol plaques), as well as the level of sugar and potassium ( that help cells work.

To determine the cause that caused the migration of the pacemaker, such diagnostic procedures are carried out.

1. Electrocardiography. This procedure is the main method for determining the location of electrical impulses and their displacement, migration through the atria and even through the ventricles.
2. Holter monitoring. For one or several days, the patient walks with a device that records the electrocardiogram readings. This examination helps to identify episodes of arrhythmia. In addition, it becomes possible to determine the pacemaker migration, its duration and time of occurrence. You can also identify the causes that caused such a problem.
3. Echocardiography. The procedure will show if there are changes in the heart structures, such as heart valves, walls or septa.
4. Phonocardiography. It is not prescribed as often as other diagnostic methods, but this examination is able to record murmurs and heart sounds.

Treatment methods for pacemaker migration

In case of negative diagnostic results, no treatment is prescribed. However, if the pathology is caused by a disease of the cardiovascular system, then it can be eliminated with the help of appropriate treatment.

The method of treatment depends on what disease caused the migration of the pacemaker.

1. SSSU. With sick sinus syndrome, the only way out is to install a pacemaker.
2. Ischemia. Such a disease requires medical treatment. Doctors prescribe statins, drugs that prevent blood clots, beta-blockers, and angiotensin-converting enzyme inhibitors. If the patient has attacks of heart pain, then it is advised to take nitroglycerin.
3. Inflammation of the myocardium. Of the drugs, the patient is prescribed antiviral and antibacterial drugs. It is also recommended to avoid physical activity for several months.
4. Heart valve defects. In this case, treatment is aimed at eliminating individual symptoms of heart failure. Doctors prescribe diuretics, glycosides, beta-blockers, angiotensin-converting enzyme inhibitors, drugs that prevent blood clots, and drugs that dilate blood vessels. If the situation is particularly difficult, then a surgical operation is performed, during which the valve is reconstructed or replaced with a prosthesis.
5. Vegetovascular dystonia of the hypotonic type. As a drug therapy, the patient takes neurometabolic stimulants. The daily life of a person undergoes great changes. Doctors advise making serious adjustments to the lifestyle, for example, on a regular basis, include adequate physical activity (playing sports or at least exercising and walking), quitting smoking and drinking alcohol, frequent exposure to fresh air, good rest. A diet that emphasizes vegetables, fruits, dried fruits, nuts, and fish is also recommended.

If the migration of the pacemaker does not have a specific reason, then such a deviation should not cause serious concern. Often this problem is diagnosed in people at a young and even childhood age, and quite often it goes away by itself.

Preventive measures

The main preventive task is to maintain a healthy lifestyle.

• healthy eating (this item includes control over the amount of food taken, moderate consumption of animal fats, the inclusion of vegetables, fruits, dried fruits, fish in the diet);
• refusal of alcohol (men are allowed to take no more than 30 ml of ethyl alcohol per day);
• giving up cigarettes;
• adequate physical activity;
• weight control (in case of obesity, it is recommended to lose weight);

Since the migration of the pacemaker often appears due to any disease, it is recommended to prevent diseases that can provoke such a deviation.