First check-up and setting adjustments. In a foreign country.

Had dual lead St Jude PM fitted 12 weeks ago for Heart Block, after fainting during exercise. 40yo, otherwise very fit and active (competing athlete). Partial problem to all this - I'm in a foreign country where I'm learning the language - so I don't understand the full diagnosis.

Initially set to DDD, but for some reason, in the first week it kept pacing me at exactly 120bpm for long periods (did it for 8 hours one day) which was distressing and uncomfortable. It was difficult to get this message across to my doc (they tried to convince me it was AF), but eventually they set it to VVI mode and sent me on my way after I showed them data from my HR monitor.

Since then, I've not had the 120bpm problem, but feel that the PM could be optimized to my circumstances - e.g. dual lead unit, very active, young(ish), technically minded. I still get a very irregular beat. I also now get out of breath a lot easier.

 

First Q - why might DDD result in constant pacing of 120bpm (could it be a safety setting).

Second Q - how can I tell if I'm being paced (during exersise for example) - is this data only available on download?

Third Q - what kind of settings will help me with getting back to some moderate training?

 

2 Comments

What's the word for ______?

by Gotrhythm - 2020-02-04 14:50:25

This is hard. Pacemaker stuff is hard enough to understand in one's native language.

My only suggestion is to find an interpreter who can handle "medicalese" even if you have to pay someone.

These days when the internet allows us to contact anyone, anywhere, there must be someone fluent in both languages and in medical-speak who can help you find your way.

There migh even be someone at the Pacemaker Club if you tell us what language is proving to be a barrier for you.

DDD vs. VVI

by AgentX86 - 2020-02-04 15:20:57

VVI (I assume you meant VVIR) is inappropriate for anyone who is athletic.  With heart block it will cause AV dyssynchrony, making the atria less than useful. I'm paced VVIR but with the intention of isolating the atria, purposefully causing the dyssynchrony. However,  athletes need the atrial  "kick" (something like 20% improved heart output).

DDD preserves AV synchrony - the whole point of the pacemaker is to replace the dysfunctional AV node.

Something else is going on. If your 120bpm heart rate was irregular,  it was likely caused by Afib. If it was regular, maybe Aflutter. The fact that it comes and goes supports this guess. Any cardiologist worth the title should be able to see these on an EKG. IOW, it's probably not the pacemaker. Switching you to VVI(R) mode eliminates the arrhythmia (can't conduct to the ventricles), at the cost of cardiac performance. That's where I am, but with an international heart block.

Note: If you're truly in VVI mode, rather than VVIR, it would explain a lot more. Your pacemaker couldn't change heart rate at all, leaving you oxygen starved with any exercise.

A1: See above. Afib/flutter explains it all. Best guess.

A2: You can't,  though if you had a third degree block, the answer is simple - Always in the ventricles. DDD mode: You don't know about atrial pacing - depends on your sinus node. VVI mode: There is no atrial pacing.

A3: First, get back to DDD pacing. If you do have Afib/flutter,  you'll need to get that under control before DDD will help much.

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