Dialing in the Boston Scientific Accolade, RYTHMIQ, Lower Rate Limit, Paced AV Delay

• by primaldiva
• 2018-01-10 12:37:49
• Checkups & Settings
• 1941 views
• 1 comments

Hi all--

Just had my leads and Medtronic Adapta pacemaker extracted several days ago and I am already trying to dial in my new BosSci system. I really appreciate the help I have gotten in the past on this website regarding my Adapta and how difficult it was to dial that one in: at the end of the day, it was a very poor choice for this cyclist and I'm pretty happy to see  it go. It never really worked for me, I was constantly overpaced just to be able to exercise.  

Key points:

^I have a very low resting heart rate genetically, and also due to being a lifelong endurance athlete.  I routinely see heart rates in the high 30s even when awake.  Resting is about 36. NO EVIDENCE OF CHRONOTROPIC INCOMPETENCE. When I train, my heart rate rises and falls as it should, although I still block, mostly Wenkebach, so once the heart rises I do need to be paced in the ventricle.  My AV node is unpredictable, no evidence of His-Purkinje disease. 

^Adapta had a night setting mode which allowed my LL to be set at 35, it was 40 during the day. Accolade will allow them to set a LL of 35 but it would have to be all day. They will fight me on this, but with no evidence of Sinus node dysfunction I don't see why I can't just let my heart be as efficient as it prefers.  Thoughts?

^Right now they said they tried to "match" my Adapta settings before I left hospital so I am in DDD mode (NOT DDDR as they wanted)  When I was in DDDR mode with the Adapta my ventricular pacing rate jumped from 9-65% and I had a ton of PVCs and PACs.  Worse there was actual damage to my heart muscle from all of the unnecessary pacing. (confirmed with transthoracic echo) With a functioning sinus node, the Rate Response mode seems to do more harm than good. With RR turned off, I was able to eventually get my pacing back down to 24% with the Medtronic unit until the leads started to fail prematurely.

^RHTHMIQ  is set at AAI with VVI backup (This is similar to Medtronic's MVP feature which did not work for me; that is to say, it minimizes RV pacing but I am unable to exercise without excessive fatigue due to block)

The AV delay is set LONG at 80-350ms (the BosSci has a range rather than fixed)  I think in the spirit of changing one thing at at time, I would shorten the AV delay AFTER I tried to tweak the settings for the mode-switch algorithm, RYTHMIQ.  Any thoughts on this?  Which would you try first?

^My thresholds are testing super low. 0.4 in both chambers. I have not been paced at all in the current settings since implantation on 1/4/2018, but walking up stairs/ bike intervals has felt pretty awful. So we know I need to live somewhere between 0% and 24%.

Sorry for the long post and thanks in advance.  I am heading into the lab tomorrow, Thursday the 11th, so even if you cannot comment on everything, feel free to take a stab at what I should start with.  Was thinking of dragging my bike into the lab but I think they will be pissed to see me carrying anything so early.  Next visit!  

Andrea