Stress Echocardiograph results

Please help with the interpretation of "No atrial pacing during exercise". I understand most of the repport except this phrase. Does this mean that my heart did not pace on it's own during the exercise and I was reliant on the pacemaker's atrial lead?

I have had progressively worse breathlessness and weak legs on exertion. It started in January and I had the pacemaker taken out in April due to blood culture negative endocarditis with a 12mm vegetation on the paemaker lead in the right atrium. A new  pacemaker was put in a week later but IV antibiotics were not commenced until 5 weeks post-op. On-going night sweats were thought to be due to unresolved endocarditis.

A summary of the results of the stress Echocardiogram:

Moderately poor exercise capacity limited by breathlessness without chestpain or discofort.

Negative stress ECG at relatively slow heart rate(70% of maximum) (113 bpm when expected 161bpm)

Negative stress echo for myocardial ischaemia at submaximal heat rate response. Normal left and right ventricular contractile reserve.

Some degree of chronotropic incompetence. No atrial pacing during exercise.

A small ovoid echodensity in the right ventricular outflow tract close to or attached to the septal tricuspid leaflet at the base. Vegetation, active or otherwise not excluded.

 

Any insights or explanations would be appreciated.

4 Comments

Not sure

by AgentX86 - 2018-08-18 00:29:45

Not sure what "No atrial pacing during exercise" means but normally "pacing" means that the pacemaker is providing the pulses, not the SI node.  "No atrial pacing" would tell me that the pacemaker is not doing anything, at least in the atrium.  This may not mean that everything is normal.  There may be no atrial tcontractions at all and running completely in VV mode.  There isn't enough information here.  These are questions for your EP/Cardiologist.

pacing

by Tracey_E - 2018-08-19 12:55:51

If it says no atrial pacing, that means you were beating on your own at that time and your heart was setting the pace. Chronotropic incompetence means your rate was not going up adequately on exertion. It sounds like maybe your rate response is not turned on but should be. Or if it's on, the settings should be fine tuned so it kicks in faster on exertion. Pacing can fix CI. 

What's it all about?

by Gotrhythm - 2018-08-19 13:19:51

LIke AgentX86 I really need more information to give a complete answer. However, atrial pacing would refer to the action on the pacemaker. The medical term for the heart's natural "pacemaker" is the sinus node.

I would say that this report indicates that the pacemaker isn't pacing your heart in the atrium. What I don't know is whether the sinus node is functioning adequately and that's why the atrium is not being paced, or something is wrong with the atrial lead and that's why. 

Since the report also says chronotropic incompetence, a lack of pacing might be indicating that the activity of your sinus node is sufficient when you are at rest, but as Tracey says, it can't speed up on it's on, and the pacemaker is not set to help it speed up when you exercise.

 

Stress Echo results

by Selwyn - 2018-08-20 12:40:55

The chronotrophic incompetence really goes with the failure to reach maximum heart rate during exercise and that the atria cannot fully function when you exercise ( hence the difficulty with breathing during exercise as your heart is working submaximally. ) Sound like the start of a 'sick sinus' syndrome. 

The endocarditis may have produced tissue overgrowth of the inside covering of your heart muscle ( endocardium)  and the small ovoid echodensity in the right ventricular outflow tract is evidence of this. It is of concern that it should not break away and cause an embolus.  I trust you are anticoagulated, you should be. The stability of the tissue overgrowth ( the 'vegetation') is of paramount importance.

Selwyn 

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