Just had a clinic visit...

and had a huge breakthrough with my recurrent arrythmia post-PM!

Long story made extremely short, failed ablation led to PM in March due to AV node getting damaged. 100% paced ventricular, 60% atrial. Recurrent Sinus Tachycardia post PM implant.

I am going to get some of this terminology wrong, but my Sinus Tachycardia was popping up throughout the day (130 bpm), but I didn't feel it until I got home from work etc etc and my body started to relax. Then the episodes became more noticeable.

My PM tech and doctor work very closely with me yesterday, and they notice that a P-wave (PVARP) is slipping through undetected by the PM, and this missed P-wave leads to the initiation of the ST. So instead of having some type of a variable P-wave setting, they fixed the rate at 330ms and things are definitely different... The ST is getting circumvented because of the fixed PVARP setting.

Someone can correct what I am trying to explain here, but I am pretty excited because I have gone 24 hours without even a slight bout of ST, and that hasn't happened since I got this PM thingy...

DC

1 Comments

Great news your pacer is adjusted!

by pacemaker writer - 2010-01-09 01:01:49

No corrections, but I can explain it more like they do in the patient literature ... Every now and then your atria would beat but the pacemaker did not "see" it. It had to do with the way the pacemaker's settings were arranged--the atrial beat fell in a "blind spot" (which was during the PVARP timing cycle).

The pacemaker didn't see an atrial beat so it figured your heart did not beat as it should. The pacemaker--doing what pacemakers should--tried to fill in the missing beat.

The problem was you didn't need an extra beat because that atrial beat wasn't missing at all! Now your atria are beating on their own and the pacemaker is pacing, too. Result: your atrial rate is now twice as fast as it should be!

A pacer doc would call this "atrial undersensing." Undersensing always leads to over-pacing.

By adjusting the "blind spot" a bit, your pacemaker now has a clearer view of what is happening in your heart.

This kind of thing can be highly individual. Most pacemakers are shipped from the factory at "nominal" settings which are the ones that work well for most patients. Well, most is not all! Sometimes the settings need adjustment. That's why you need a good pacing specialist and a lot of patience and perseverance to get things straightened out.

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