Hospital ER says Afib, Pacemaker says no

I was in the ER about 10 days ago for 24 hour observation as a result of some stomach issues. While there, they had me hooked up to all kinds of monitors. On the screen, it was obvious to the doctor (I could not see it) that there was some Afib. Nothing serious but they could see indications. Today, 10 days later, I had a pacemaker (St Judes) checkup on my 6 year old pacemaker. The technician said there was no evidence of any Afib ever having occurred since installation 6 years ago. Is there any explanation of why there is no record of Afib on the pacemaker but it did show up on the monitor at the hospital? Two months ago I was in a different hospital for 4 days for surgery and their monitors showed no evidence of Afib. Strange!!

4 Comments

thoughts

by The real Patch - 2017-07-18 18:56:01

a couple thoughts. First, your device only records what they tell it too. Because there is limited memory they program it what type dataq to record. So there is the remote possibility it wasn't programmed to collect A-Fib episodes (I think that a remote possibility but still).

Second, many doctors cannot read an EKG (or ECG if you will) of people who are paced. My Cardiologist pointed that fact out to me long ago. The last time I had to visit the ER two doctors proved my Cardiologist's point and mis-read my EKG. You'd be surprised at how few doctors are knowlegeable about our electronics. 

I wouldn't worry about it

Will Check with Tech

by gooch - 2017-07-18 23:06:55

Thanks for the info. Will be having another PM check in two months and will make sure to find out if it is programmed to collect A-Fib episodes

Afib Default is On ?

by gooch - 2017-07-19 08:57:27

I have a St Jude PM2210 installed 2011. Is the default for this device set to collect A-Fib epsisodes? The tech said it is always on and cannot be turned off.

AMS mode printout for St Jude Pacemaker

by Selwyn - 2017-07-19 12:13:27

The AMS mode ( for my St Jude, verity), that is the automatic mode switch, is aways on ( I am unsure whether you can turn this off, I suspect not).  The AMS mode switches off the atrial sensing when in AF or flutter, or similar. The frequency and duration are counted. You thus have a built in counter for AF ( and flutter).  This can be reset to zero at your PM check up.

Who to believe? I have always found my pacemaker check print out to be reliable. Ask for a copy and see the data associated with AMS. 

It is possible to misdiagnose atrial fibrilliation on ECG( EKG) as the absence of P waves can be difficult to see ( especially if there is a lot of  'background noise'.  The ECG machines are notorious at misdiagnosing using the automated reading programmes.  I have all sorts of terrible diagnoses printed out for me from these interpretive machines. 

In summary: see the St Jude print out from your PM check-up. Seeing yourself the AMS data is unlikely to be misleading, though remember other fast atrial arhythmias may activate the AMS, not just atrial fibrillation.

For further insight into AMS see:

Indian Pacing and Electrophysiology Journal , 5(3): 186-196 ( 2005), and article by Stabile, De Simone, and Romano.

Kind regards,

Selwyn

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