re: PVCs

Frank - I just came back from my check up with the St. Jude tech - very, very disappointing!
Fact 1. I have bipolar mode.
Fact 2 - Before Jan 2011 the sensor is off because I don't need it. Settings were 60-130. No problems. - EVER!
Fact 3. January 2011 tech decided on her own to set my upper level to 150 because of my activity level. Problems started immediately. PVCs? Little "stings" sproadically.
Fact 4. To see if problems would go away, level set back down to 140. Still some problems but not as bad.
Fact 5. Level set back down to 130. Very little problem - even less than 140 but brakes went on the more active I was.
Fact 6. Brakes NEVER went on with the original setting of 130 before January 2011. Could the intense heat here in Florida cause the "brakes" to go on?
Fact 7. Never really got answers to my "WHY" questions because she was in a hurry to meet a surgeon to aid in implant surgery.
Fact 8. I did ask her to go back in my history BEFORE the 150 setting to check every spec to now and compare.

I see the doctor this coming Monday. I guess I am a stickler for detail and prefer to have logical answers to logical questions which I cannot seem to get out of the doctor. I want to know the "WHY" problems occured when settings were changed unilateraly by the tech and agreed to by the doctor to accommodate my activity level.
Fact 9. The tracking rate is now at 140, sensor always off because my atrial work 100% on its own but the PM works the right ventricle 100% of the time.

I'm sorry but I don't understand why I cannot get answers - no one seems to know. I asked for the specs like you said but I'll have to get them at another time since the tech had to leave so fast.

Help!

Connie

3 Comments

Strange

by ElectricFrank - 2011-08-12 02:08:23

The question I would have is in Jan 1011 were there any other changes along with the Upper Tracking Rate being increased to 150. Some of the terminology is strange to me and makes me wonder how well she understands what she is doing.

Try to get the printout so we can confirm what is happening. There is another mode setting that determines how the pacer is handle both chambers. If the mode is DDD then Rate Response is off. If it is DDDR then RR is on. If RR is off then the pacer only has an upper atrial tracking limit which determines how fast the atrium can go and still have the ventricles track. The only way turning this limit up is if your atrium is having periodic extra beats. These would feel like PVC's but technically aren't.

If RR is on then there is a second upper limit in effect which sets the upper limit for rate pacing. It also affects how fast the rate increases with activity. If this was turned up it could cause activity to cause rate interference with your normal pacer. This is what they did to me in the beginning.

This is all kind of hard to describe without being able to draw diagrams.

good luck,

frank

not to intrude..

by sam78 - 2011-08-13 03:08:02

Sorry dont mean to intrude on your conversation... but Connie did you happen to ask them how many PVC's you are having? Like Frank said, a copy of your pacer interrogation or just asking them will give you a much better indication of whether your little stings are PVC's or something else. Like Frank said.. the rate response on or off can make a big difference.. or at least it did for me.. I noticed all kinds of stings and goofy beats with the rate response on.

Hi

by Davey5 - 2011-08-15 03:08:46

I hope you don't mind my making assumptions but from your profile it says you are retired possibly through age?
If so, an upper pacing rate of 150 is far too high and could certainly present you with what you are feeling. 130ppm is the absolute maximum I would ever suggest for the more mature patient.

Without seeing your pm interrogation though it's quite difficult to suggest what, if anything could do with tweaking.
Certainly one thing I would ask about is whether there is any way of reducing the pacing to the ventricle by extending the av delay or by putting ventricular intrinsic preference on ( if your model has this feature anyway).
One thing's for sure though, I would ask to see a different tech next time you go for a follow up.

Dave

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