Interrogation Report

To deal with AFib have a pacemaker programmed to ensure my heartrate cannot go below 50.

I have kept, and am trying to better understand, all my interrogation reports.

My VHR detection has been set for 150 ppm for 10 beats.

Originally, I had hoped that the interrogation report would track AND REPORT USING (say a) LINE CHART all heart activity 24/7. This way I could best understand (and change, if necessary) how lifestyle matters might be affecting my heart. Unfortunately (for reasons, I am told, of power consumption) it does not do this, instead providing more general average (not sure if it is average or median) reports of heart activity over the period between telephone unit call ins.

Thus far, the most telling bit of invormation has been Ventricular High (heart) Rate Episodes (VHR): Starting three months ago, and for a two month period, my VHR Episodes was 1817. In the last month, that rate dropped to 57 because of the introduction of metoprolol to my heart medications.

Adding metoprolol to my calcium channel blockers has in the past been problematic for two reasons: 1) I have extremely low blood pressure and any drug that brings it further down can be dangerous; 2) I have taken metoprolol and experienced significant depression. So now I have cut my metoprolol in half to see—after a month—how that effects my VHR.

I would like to understand and use my Interrogation Reports as best I can.

My question is: Besides VHR, what other Interrogation Report categories and results should I pay attention to?

3 Comments

VHR?

by golden_snitch - 2015-06-27 02:06:04

Hi!

I am not sure that I understand what you are so focused on ventricular high rate episodes when you have Afib. Usually, when Afib causes the ventricles to beat fast that is still considered an atrial high rate episode: the atrial rhythm is fast, and that causes the ventricles to beat fast, too. Ventricular high rate is for tachycardia originating in the ventricles (v-tach, ventricular flutter or fibrillation), and that is a very serious condition that is usually not be treated with a pacemaker, but rather an ICD.

Your pacemaker should at least show an heart heart curve covering the past 24 hours, in addition to the overall trends between your interrogations. I have had pacemakers from three different manufacturers, and they all provided a curve for the past 24 hours (one actually provided one curve for each of the past seven days).

I'd think that for an Afib patient, the "Afib burden" is of interest in the pacemaker report. Maybe also mode switch episodes because of Afib.

Best wishes!

Atrial Long Term Histogram Section

by AfibBIPAPASV - 2015-06-29 02:06:07

Like you said, Atrial high rate episodes are reflected in ventricular high rate episodes. For some reason (that I realize I don’t understand), it is the VHR episode count that we use to gauge whether my drugs are working.

Is any of the information shown below of use? It seems the most specific in terms of Afib monitoring.

It’s from the report’s
ATRIAL LONG TERM HISTOGRAM SECTION
(I hope I can fit it into the forum column width. I can’t figure out how to insert a graphic)

MODE SWITCHES: 4 (PERCENT OF TIME: 100.0%)
ATRIAL HIGH RATE EPISODES: 4
EPISODE TRIGGER: MODE SWITCH > 30 SEC

Date/Time Duration Rate(bpm)
hh.mm.ss Max A Max V
03/18/15 > 96:00:00 Fastest… >400 192
03/31/15 > 96:00:00 Suspended… >400 219
04/30/15 > 96:00:00 Suspended… >400 202



VENTRICULAR HIGH RATE EPISODES: 1,817
Date/Time Duration Rate(bpm)
hh.mm.ss Max A Max V

03/18/15 9:51 AM :01:14 First >400 171
04/26/15 2:48 PM 2:30:48 Longest >400 202
04/27/15 11:36 AM :44:18 Fastest >400 219
05/18/15 8:38 PM :01:08 Last >400 163

Pacing (% of total) Event Counters
AS – VS 99.5% PVC singles 188,907
AS – VS .2% PVC runs 5,860
AS – VS <0.1% PVC runs 4,059,369
AS – VS 0.3%
MVP On

Can you help me understand this section?

Statistics

by golden_snitch - 2015-06-29 02:06:57

No, I said, atrial high rate episodes are for instance Afib or Aflutter episodes, while ventricular high rate episodes are usually tachycardias that originate in the ventricles. Your ventricles in that case do not beat fast because the atria tell them to, but because something in the ventricles is causing them to beat fast.

I don't understand your pacemaker report well. Don't get what the >400 means. My guess would be that it's the atrial rate which would mean atrial fibrillation. If that is true, your ventricular high rate episodes were not real ventricular tachys, but tachy caused by the atria fibrillating. But then the atrial high rate episode counter with just 4 episodes is wrong. Ask your cardio/pacemaker rep to explain this to you.

You hardly pace at all: AS = atrial sensing / VS = ventricular sensing is 99.5%, so the pacemaker mainly just watches (senses) what's going on, it doesn't pace (AP/VP stands for pacing).

PVCs are premature ventricular contraction = extra beats from the ventricles.

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