Ventricular Tachycardia

Hi!,
In the past you have been a great help. Thank you. I hope you can help me again. I had my pacemaker implanted in 2004, and I have third degree heart block. I just came home from the hospital with what my doctor says is "pacemaker ventricular tachycardia." I have had this before, my settings have been changed, but I continue to have this problem. My doctor seems unsure of what to do next. My question: Is this condition serious? Could I die from it? What do you think I could do about it? Has anyone had this condition? Thank you. Ariela

4 Comments

Pacemaker Mediated Tachycardia

by ela-girl - 2008-05-27 04:05:49

Hi, Ariela.

I have had one episode of PMT since having my pm for two years. This happens in dual chamber pm's. There is a settng on your pm that your doc should be able to adjust that will keep your pm from sending you into VT. I will have to pull out my report to see what it is as I can't remember the name for the setting at the moment. It is kinda like a delay setting that allows your beats to go as they were even when they take an extra second. It keeps the pm for kicking in when it isn't needed. My EP explained this PMT condition to me is such an easy to understand way. I don't think I can repeat it without thinking about it again for a minute. Something about your heart is going along at a lub-dub lub-dub being paced in the atrium and ventricle. Let's say you are being paced in the atrium but your AV node makes the ventricular beat before the pm and sends it to the atrium before the next atrial-paced beat. Well, the pm is still trying to pace the ventricular beat, too, so you get this cycle that triggers the pacemaker to repeatedly pace the ventricle--hence the VT.

I don't know if that made sense or if I said that right. Hopefully, Smitty or EFrank can help here!

You shouldn't have any problems with the pm VT because the pacemaker will catch it in a matter of a minute and 'reset'. Not to say it is fun. You may have palpitations or chest discomfort or feel light headed. What is the condition you have your pm for? And do you have an EP?

Ok. I tried!
ela-girl

EP

by ela-girl - 2008-05-28 01:05:30

Well, if it is at all possible for you, you may want to get a second opinion and some fresh eyes on your problem. Sometimes that is all it takes. Whatever you do, don't give up and be persistent.YOU have to be your best advocate. Do you ever have someone go with you to your appointments to be your extra eyes/ears/muscle? Have you ever seen one of the EP's? Regardless if they are super busy or whatnot I would try to see one because they are cardiologists with 2 or more years of specialized training in the electrical system of the heart. And the problem you have dear Ariela is an electrical problem. And if your current cardio isn't doing any more to help you, I think it is time to move on. You shouldn't be fighting this PMT without hope. What kind of pacer do you have? You could call the 800 number on the back of your pm i.d. card and ask them if there is a setting to deal with the PMT...then you could pass that info. to your doc or the next doc and the pm tech. Have you ever had any tests to make sure that you don't have ventricular problems like a tachy-brady arrhythmia or SVT or something? I can understand your concerns since your father died of SCD. Your heart is a major organ not to be taken lightly. Are you on any heart meds?

These are my current thoughts...what do you think?

ela-girl

Problems

by SMITTY - 2008-05-28 11:05:27

Hi, Ariela

I can't add much to what ela-girl has said. Except, I have a pacemaker with the rate response activated and feel that "big thump" you describe. As ela-girl said, that is probably coming from the ventricle receiving an electrical impulse from your PM and trying to contract before the atrial has finished it's job of transferring blood to the ventricle. This causes the mitral valve between the two chambers to have pressure applied from two directions and that will result in pain.

A PM with the correct settings will not be out of sync with your hearts natural pacemaking function and this pain can be avoided. The catch is that getting the correct settings is in reality a trial and error process and can take several attempts before the correct one are realized. Just remember help is available, so don't give up.

Good luck,

Smitty

Thanks

by Ariela - 2008-05-28 12:05:20

Dear ela-girl:
Thank you for your explanation. It made me feel better. The only thing I know about my condition is that I have third degree heart block, and I am 86% dependent on my pacemaker. The bottom part of my heart occasionally beats, but neither often nor constantly. Sunday, while in the hospital, my cardiologist said that since January I have had 478 "episodes" of this pacemaker ventricular tachycardia. Often I'll feel dizzy, with difficulty to take a breath, and somewhat confused. At this time my blood pressure drops quickly to about 80/63 more or less. I can feel when this is about to happen -- I have a big thump or two in my chest, followed by the pacemaker or something racing in my chest. I live in a small town and we have only 2 electrophysiologists -- both of whom are very busy. I see a regular cardiologist twice/year and a pacemaker tech every 4 months. I need to learn more about this situation so I can ask good questions to my cardiologist. I have no idea if this condition is common, serious, or just something to be ignored. My dad died of sudden death syndrome ... and I have no idea that this could happen to me. What should I ask my cardiologist?

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