Taking your pulse when you have a pacemaker or ICD: helpful habit or anxiety inducing?

If you have a pacemaker or an ICD, it is very common to become more aware of your heartbeat. Many people start checking their pulse more often, especially after an unusual sensation in the chest, a flutter, a thump, dizziness, or a spell of breathlessness. Some people do it for reassurance, others because a clinician advised it, and some because a smartwatch or phone notification has made them curious or concerned.

Pulse checking can be genuinely valuable. It can also become misleading, and in some cases it can increase anxiety rather than reduce it. The key is to understand what a pulse can tell you, what it cannot tell you, and how to use it in a way that supports your health rather than takes over your life.

This article explains the positives and the negatives of monitoring your pulse, why readings can be inaccurate in common rhythms such as ectopics and atrial fibrillation, why pacemaker paced beats can sometimes feel different from your own natural beats, and why symptoms should always carry more weight than a number.

What do we mean by “taking your pulse”?

When you feel for your pulse at the wrist or neck, you are not directly feeling the electrical activity of the heart. You are feeling the pressure wave created when the heart pumps blood into the arteries. Most of the time, each heartbeat creates a pulse wave you can feel. But not always.

That difference matters, particularly for people with irregular rhythms, extra beats, atrial fibrillation, or pacing.

How to check your pulse

The positive side: when pulse monitoring is genuinely useful

1) It can help you spot a change early

If your pulse suddenly becomes very fast at rest, very slow compared with your usual, or clearly irregular when it is normally steady, that change can be an early clue that something has shifted. For example, atrial fibrillation can cause a pulse that feels irregularly irregular. If you notice a new pattern and you are also symptomatic, it is sensible to contact your GP or cardiology team.

2) It can add context to symptoms

Symptoms alone can be hard to describe in the moment. A quick pulse check can help you explain what you experienced. For instance, “I felt dizzy and my pulse felt very fast and irregular for five minutes” is more useful than “I felt odd”.

3) It can support self-management and confidence

For some people, learning how their pulse behaves with exercise, stress, caffeine, alcohol, dehydration, or poor sleep can be empowering. It can also help people pace activity during recovery after a procedure or illness. When used calmly and consistently, pulse checks can turn uncertainty into understanding.

4) It can guide sensible decisions, not panic

If you feel palpitations but your pulse is steady and your symptoms settle quickly, that can be reassuring. If you feel unwell and your pulse is persistently abnormal, it can prompt you to seek help sooner. The aim is not to diagnose yourself, but to make better decisions about whether to wait, rest, hydrate, or call for advice.

The negative side: how pulse monitoring can mislead or increase anxiety

1) Pulse readings can be inaccurate in common situations

Pulse checks are a blunt tool. They work best when the rhythm is regular. In irregular rhythms, you may count wrong, or the pulse you feel may not match what the heart is doing electrically. Smartwatches can also misread in these situations.

2) It can turn normal body awareness into constant checking

Many people fall into a pattern of repeated checking, especially after an ICD shock, an episode of palpitations, or an alert from a wearable. This can create a cycle: you check because you feel anxious, the checking makes you more alert to sensations, that makes you check again.

3) A number can feel like a verdict

Seeing “95” or “45” can trigger worry even when it is harmless in context. Heart rate varies naturally with breathing, posture, hydration, medication, pain, infection, stress, and physical activity. A single reading without context can frighten people unnecessarily.

4) Over monitoring can distract from what matters most

A pulse rate does not measure blood pressure, oxygen levels, circulation, or the safety of your rhythm. Most importantly, it does not always correlate with how well you are perfusing, especially if there are extra beats or atrial fibrillation. You can have a “good number” and still feel unwell, or a “scary number” and be perfectly safe.

Why ectopic beats can make your pulse feel wrong

Ectopic beats are extra beats that can come from the atria or ventricles. Many people describe them as a skipped beat or a thump. What is happening is often an early beat followed by a pause, then a stronger beat.

Here is the important part for pulse checking: an ectopic beat does not always produce a strong pulse wave you can feel at the wrist. Because it comes early, the heart may not have filled properly with blood, so the pump is weaker. That means you might feel an irregular rhythm but undercount the true number of beats, or you might feel “gaps” that are not actually your heart stopping.

So a manual pulse check during frequent ectopics can look slower than reality, and it can feel more alarming than it is. This is one reason clinicians often prioritise symptom pattern and an ECG tracing rather than pulse alone.

Atrial fibrillation and the “pulse deficit” problem

Atrial fibrillation is a rhythm where the upper chambers of the heart quiver rather than contract effectively. The ventricles receive irregular signals, so the heartbeat becomes irregular. In AF, the pulse at the wrist can be very difficult to count accurately, and there is another complication.

Not every electrical beat in AF creates an effective mechanical beat that generates a clear pulse wave. Some beats are too weak to produce a palpable pulse. This mismatch between the heart’s electrical rate and the pulse you feel is often called a pulse deficit.

What does this mean in real life?

• Your heart may be beating faster than you can count at the wrist.

• A smartwatch using optical sensors may struggle, especially if the rhythm is irregular and the signal is noisy.

• You might think your heart rate is “not too bad” when it is actually higher, or you might get inconsistent readings from one minute to the next.

This is why an ECG recording is needed to diagnose atrial fibrillation properly, and why rate assessment in AF is ideally done using a reliable recording rather than a quick pulse count.

Paced beats can feel different from intrinsic beats

If you have a pacemaker, some of your heartbeats may be your own natural beats (intrinsic), and some may be paced. Many people assume a paced beat will always feel the same as an intrinsic beat. In reality, it can sometimes feel different, and it can also affect what you feel at the pulse.

Reasons include:

1) Timing changes

A pacemaker delivers a beat at a specific moment to prevent the heart going too slow or missing beats. If pacing occurs after a pause, the first beat after that pause can feel stronger, simply because the heart filled more.

2) Different activation patterns

Depending on where pacing is delivered, the way the heart muscle contracts can be slightly different from your natural conduction. Many patients feel nothing at all, but some feel a different “quality” to the beat, especially at rest or when lying on their left side.

3) Mixed rhythms can confuse the pulse

If you have a pattern where intrinsic beats and paced beats alternate, your pulse may feel uneven in strength even when the device is doing exactly what it should. That unevenness can lead to worry if you are relying on pulse feel alone.

For ICD patients, the same principle applies regarding what you feel. The ICD monitors rhythm and delivers therapy, if necessary, but your pulse sensation is still a mechanical signal and does not always map neatly onto electrical behaviour.

Symptoms matter more than the number

A pulse reading is one piece of information. Symptoms are often more important because they tell you how your body is coping.

A sensible way to think about it is:

• A number without symptoms is often less urgent, especially if it settles quickly and you feel well.

• Symptoms without a dramatic number still deserve attention. You can feel faint, breathless, or have chest pain even when the pulse rate looks acceptable.

• Symptoms plus a persistent abnormal pulse is when you should be more proactive in seeking advice.

Symptoms that should prompt urgent medical assessment include chest pain that does not go away, severe breathlessness, fainting or near fainting, or signs of stroke. If you have an ICD and receive a shock, you should follow the plan given by your cardiology team and seek urgent help if you feel unwell or receive repeated shocks.

Smartwatches and home devices: helpful, but with limitations

Wearables can be a brilliant addition for some patients. They can help in three main ways:

1) Trend tracking

Seeing your typical resting range, overnight pattern, and exercise response can help you understand your baseline. Trend information is often more useful than a single reading.

2) Capturing episodes

Some watches can record a single lead ECG, and many can flag irregular pulse patterns. If you get symptoms and can capture a recording, that can be very helpful for clinicians, particularly for intermittent palpitations.

3) Encouraging healthy habits

Many people walk more, sleep better, and manage stress more proactively when they can see patterns.

But limitations are real:

• Optical heart rate sensors can struggle with irregular rhythms, movement, poor skin contact, tattoos, low perfusion, or cold hands.

• False alerts can happen, particularly in people with a low likelihood of arrhythmia, and false alerts can increase anxiety and reduce confidence.

• A consumer wearable is not a substitute for medical assessment, and it cannot fully interpret complex rhythms in the way a clinical ECG can.

The balanced approach is to treat the watch as an extra clue, not a judge and jury. If it reassures you and helps you capture symptoms, great. If it fuels constant checking, it may be worth adjusting settings, reducing notifications, or agreeing a plan with your clinician about when to act on an alert.

The psychological impact: reassurance versus anxiety

Positive psychological effects

For some people, pulse checking restores a sense of control after a life event. It can build confidence that the heart is steady during activity. It can also reduce uncertainty when done in a planned, limited way, such as checking once daily for a short period after a medication change or checking only when symptomatic.

Negative psychological effects

For others, pulse monitoring becomes a form of safety seeking behaviour. It can keep the nervous system in a heightened state and make normal sensations feel threatening. This is especially common aftershocks, hospital admissions, or distressing palpitations.

If you recognise a pattern of frequent checking, fear of being alone, avoidance of activity, or repeated reassurance seeking, it does not mean you are weak. It means your body has learned to associate a sensation with danger. That can be unlearned with education, a clear action plan, and supportive coaching.

A practical and calmer way to use pulse checks

If you want a simple framework that avoids over monitoring:

1. Check your pulse only in two situations

   • When you have new or worrying symptoms

   • When your clinician has asked you to monitor for a specific reason and for a defined period
     

2. If you check, do it properly

   • Sit quietly for a few minutes first

   • Count for 30 seconds and double, or for a full minute if it is irregular

   • Notice rhythm and regularity, not just speed

   • 
     

3. Write down three things

   • What you felt (symptoms)

   • What you were doing at the time

   • What the pulse felt like (fast, slow, irregular) and roughly the rate
     

4. Look for patterns, not perfection

   One odd reading is rarely the point. Repeated patterns with symptoms are more meaningful.

How HeartSync Support can help you feel less anxious and more informed

HeartSync Support works with pacemaker and ICD patients who want clear, practical guidance without alarmist messaging. Anxiety often reduces when people have a plan.

Support can include:

• Education in plain language about what your device does and does not do

• Understanding common rhythm disturbances such as ectopics and AF, and why pulse readings can be misleading

• Creating a personalised symptom and pulse plan, including what to watch for and what to ignore

• Helping you interpret smartwatch data sensibly and avoid over monitoring

• Coaching on confidence building, returning to activity, travel, and day to day living

• Guidance on what information is most useful to share with your cardiac team

The goal is not to stop you being aware of your body. The goal is to help you become aware in a calmer, more skilful way, so you can get on with life.