Expert: Ronald Levy, M.D. - 12/30/2006

Question
I'm going for a gastroscopy and colonoscopy in mid Jan.  I believe they'll lightly or heavily sedate me.  

I've a history of wpw and pacemaker in site since 1982.  Recently my heart keeps "Pause" especially after sleep.  It wakes me up few times and I waited for the beat turn up.  It turned up every time so far.  The holter said it "Pause" for 3.2 sec in the day time @ 2:14pm.  That night didn't catch any "Pause".  The cardio didn't know why my working well pacemaker didn't kick within 2.5 sec.  

The second opinion cardio said my pacer was in VVIR mode while I was in his office.  That time he said I was in V-Fib and the pacer is trying to pace out of it.  My senior cardio said I didn't have heart problem.  All fixed.  No palpitation at all.  Holter caught a lot of other events but he said it didn't make sense!  

The form that I require to fill in before the procedure for the anesthetist asked, "do I've palpitation?" I don't know should I put "Yes" or "No".  I suppose it is "No" because the senior cardio said & reassured "I got no heart problem and my heart is very normal".  Second opinion cardio said "is Fib, Fib is different to Palpitation"?  But the form didn't ask do I have Fib?

I'm worrying if I go under the sedation, my heart is "Pause" at the spot.  Would you "shock" me or you probably wait for my beat turn up by myself?  Might be they won't know at all if they didn't hook up with the monitor.  The procedure is carried out in a completely new private hospital (first time there).  Because it is a half day care and minor procedure, I don't think I would be able to see a anesthetist before the procedure.  I know I'll be having one because he or she will bill me, that's all I know.

If he or she giving me a "shock" treatment, would it damage my pacemaker?  Mine is a PCD, pacemaker and ICD in one.

Thanks for looking at my post.  I'm really need you direction.  The endoscopy was in forced to do it. It is not my idea nor I wanted. If you suggest a cancellation of the procedures, I'll consider and "Hurray"!

Pika

Answer
It sounds like a cardiologist needs to interrogate your pacemaker and make sure it is functioning correctly first. You will definitely see the anesthesiologist before the procedure and you should tell him all that you told me. What we usually do is place an external pacemaker on you so that if your ICD does not fire, the external defibrillator will convert you. But certainly you should clear up with a cardiologist the condition of your heart and the functioning of your pacemaker.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston