Can the acute cardiovascular effects of spicy food ingestion—such as transient increases in heart rate or blood pressure—trigger pacing events or alter device sensing algorithms in patients with a leadless pacemaker?
Scientific Answer:
Spicy foods, particularly those containing capsaicin, can produce acute cardiovascular effects by stimulating sympathetic nervous system activity. In patients with a leadless pacemaker, these transient physiological changes may, under specific conditions, influence pacing behavior or device sensing.
1. Sympathetic Activation and Hemodynamic Response
Capsaicin activates TRPV1 receptors, which stimulates catecholamine release (adrenaline, noradrenaline).
This causes increased heart rate (sinus tachycardia) and mild hypertension lasting several minutes post-ingestion.
In pacemaker recipients, this may transiently alter sensed intrinsic activity or inhibit pacing in demand-mode devices (e.g., VVI/R).
2. Potential Pacing and Sensing Consequences
Sensing inhibition: If sinus tachycardia occurs after a spicy meal, the pacemaker may not fire, interpreting intrinsic activity as sufficient.
Oversensing artifacts: Transient high-frequency signals (e.g., T-waves, myopotentials) may be misinterpreted as intrinsic beats, causing pacing inhibition.
Rate-responsive pacing impact: In accelerometer-based systems, increased movement may cause unintended pacing acceleration.
3. Clinical Relevance
For most patients, these effects are transient and non-clinically significant.
In individuals with borderline thresholds or autonomic instability, temporary pacing behavior anomalies may occur.
Device interrogation may show sinus variability or transient sensing irregularities.
4. Management and Recommendations
Monitor symptomatic patients with device interrogation.
Use a diet-symptom log to track reproducible patterns.
Consider reprogramming to adjust sensing sensitivity or disable rate-adaptive features.
Conclusion
Spicy food-induced cardiovascular changes are generally well tolerated, but they may transiently affect pacemaker function in some individuals. Awareness and tailored pacemaker settings help mitigate such effects.