Ventricular pacing...

I know there's a lot of information out there talking about not pacing the ventricle too much, as it can cause problems such as a-fib and the like, but I have some questions about this. I went for a check up today (since I've been passing out several times a week since April and all meds so far have pretty much failed). My doctor right away mentioned that the ventricular pacing was not in a natural rhythm. As he explained it to me, my ventricle is being paced 25% of the time and he said that if I'm getting paced that much, he'd like to see it pace at a more natural rhythm. That is, someone (one of the many cooks in the kitchen lately) had set the timing so the ventricle would be paced 350 ms after the atrial beat (so as to spare the ventricle). With even that spacing, I am paced at 25% of the time. So he set it down to 200 ms. I already think it is much better.

Now to my questions: has anyone here had any adverse effects from too much ventricular pacing? What were they? How long did it take to cause damage? Was there any treatment or alternative offered by your dr at that time? etc... And, can anyone explain to me the mechanism that might cause a delay of 350 ms to make me pass out all the time? (BP is sometimes the culprit - 75/57 last week - but could it be related?)

I'm just trying to understand and to be my own advocate. Like I told the dr. today, when I've had higher ventricular pacing, I've been stable (5 years with no passing out!!!). But you turn it off and I become a fatigued zombie with numerous bouts of unconsciousness on a weekly or even daily basis. I would rather live 15 more years with some decent quality than live 30 more years as I am right now - unable to do so many things that I enjoy and even need to do.

Any comments or suggestions?

My dx are: 2nd (or 3rd) degree heartblock (depending on which medical records you read), postural orthostatic tachycardia syndrome, and neurally-mediated hypotension. Currently taking atenolol and midodrine and will soon start florinef.

3 Comments

Ventricular Pacing

by ElectricFrank - 2011-09-27 01:09:09

I also have 3rd deg block and pace 100%. My delay is set for 170ms. I've been pacing this way since 2005 with no problems. My Rate Response is OFF since I have good sinus rhythm.

The idea of lengthening the time delay between atrial sense and ventricle pace is to allow a natural AV conduction to happen. If the ventricle fires naturally then the pace is skipped. That's OK if you only need an occasional pace, but with 25% pacing it just leads to an irregular interval.

It's hard to know what the relationship is between HR, BP, and lightheadedness. I don't seem to be very susceptible to HR or BP. Before my implant my ventricular rate would go clear down to 26bpm and I could still stand up and walk around. I just felt lousy. If I am really relaxed in my recliner my BP can drop into the 75/60 range also. I can jump up to answer the phone with no sign of passing out. I have noticed though that I get a rapid increase in BP when I jump up so maybe that's the issue. I have one of the finger type BP instruments and keep in on the stand next to the recliner.

So, I hope all this rambling is helpful. Keep in mind the data is from a well worn 81yr old body.

frank

Welcome back, Frank....

by jenny97 - 2011-09-27 10:09:05

And thanks for your comments! I really appreciate your insight and sharing of experience.

I'm guessing the concern on the side of the drs is that I am only in my mid-30s and have already had a PM for more than 11 years. They're undoubtedly concerned about the long-term effects of the ventricular pacing.

I have to admit I was kind of hoping the new setting would be the answer to my current medical drama with no further intervention required, but I'm feeling crummy again this morning. Nonetheless, I bet the new setting will at least make the paramedics feel better, now that I'll have a more natural/regular rhythm and they'll be able to see the pacer spikes since I'll be pacing more. By the time they arrive, sometimes I'm already doing better enough and the PM's not working (since it's on demand), which freaks them out. Then they try to scare me into going to the ER by telling me the PM doesn't appear to be working. I look much younger and more naive than I actually am ;)

Anyway, I hope this day goes better than it's started (for me) and great for you! Enjoy the warmth and cozy-ness of home :)

Thanks

by ElectricFrank - 2011-09-29 01:09:33

One of the strange things about cardiac issues is that the intensity of the symptoms often isn't related to the seriousness of the problem.

For instance PVC's really make us sit up and take notice, yet they are mostly benign. On the other hand sudden cardiac arrest in the young rarely has any symptoms preceding a fatal event.

I would be much more concerned about the long term effects of the cocktail of meds you are taking than I would about ventricular pacing.

best wishes,

frank

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