New Setting and Good News....

Hey, everyone!

I have been doing some research here on individuals with third degree heart block and I wanted to change the Rate Response setting on my Guidant 1291 from on to off.

I have been having difficulty with uncomfortable heart beats, irregular heart beats, and faster than normal heart beats. These would occur off and on at any time. Bending over would raise my heart rate to much. Walking to the car would send it to around 109 - 110. Although this was not uncomfortable(the faster rate) I would get short of breath to the point I'd have to sit down.

I read a lot of the posts done by ElectricFrank(thank you sir) and I asked for the Rate Response to be turned off. I reasoned with my cardio that since I have intrinsic pacing in my upper chamber and I do not have Sick Sinus Syndrome I really didn't need it(again thank you ElectricFrank for that great explanation!).

My cardio said that it was better to leave it on because the heart rate is all over the place when a person is up and about doing activity. He was a hard sell, but, he consented to let me try it. I also asked him if I could have the upper limit raised from the 130(current setting) to 150. Told him that I would like to begin walking again. But, that was a no go.

He wanted to prescribe a drug to keep my heart rate within a certain range. I declined. I don't like to take prescription drugs unless I see no other way out of a problem.

The only difference(if any) that I see is that I feel a little pressure on my chest and maybe still a little out of breath. Identical to howI feel when it's time for my nerve pill. But, I attribute that to my Chronic Anxiety and I'm not gonna jump the gun on the new setting. I'm gonna give it awhile and see if it gives me any problems.

They changed my mode from DDD.R to DDD. Didn't ask them to do that. It's like such a big puzzle. Try this setting, change that setting, you know?

I'd like to put up here the reading on my PM interrogation. If anyone has any comments about any of what I've typed feel free to do so. I've had my PM since June 12, 2007 and still only know a little more that the day that they put it in.

Finally managed to find the physician's manual for my device and boy do I have a lot to study! Ok, here are the readings.

Mode DDD
LRL 60 ppm
MTR/MSR 130/ 130 ppm

A-Sense 0.50 mV BI
A-Output 2.0 V @ 0.40 ms
V-Sense 2.5 mV BI
V-Output AUTO V @ 0.40 ms

Sensor ACC
A-Tachy Response On
AV Delay (paced) DYN -- ms

Clinical Events

Ventricular Tachycardia (Note: only lasted 2 seconds in early June)

Threshold Test Results

02 - APR - 2008 A 0.9 V @ 0.40 ms
08 - JUL - 2008 V 0.6 V @ 0.40 ms

Counters

Since 04-DEC-2007

AsVs = 1% AsVp = 85%
ApVs = 0% ApVp = 13%

ATR Mode Switches 0
ATR Mode Switch Time 0%

Battery Status

Current Status Good
Magnet Rate 100 ppm
Longevity Remaining >5.0 years
@ Current Pacing Percentage(s)

Well, that's it. I don't understand the ApVs and the ApVp data, ATR Mode data, threshold test data, the A-sense to V-sense data, and the AV delay data.

I want to thank you all from the bottom of my heart for all of the info and help that you have given to people like me. Now, I can at least ask intelligent questions when I go in for an appointment. And I brag on where I learned all of this from!

Today, when I was talking to my interrogation rep(who is a great guy) I told him why I wanted the Rate Response changed and mentioned the Sick Sinus Syndrome and the intrinsic pacing. He smiles and asks, "What have you been reading?" So, I told him!

Ya'll are the best! Thank you again and God bless!

P.S. My usage is dropping on the bottom! Last June when they put it in I was at 100% V, but now, just look! I'm at 85%, yeah!

Another thing, on the EKG readings they have me down as having first degree heart block instead of the third degree heart block in one year. I asked the Dr. about that and all he said was that nothing had changed which I'm still trying to figure out.

I saw him for the first time this past April when I left the other cardio in Roanoke. So, maybe this Dr. meant nothing had changed since April? I don't know, lol!

To me, to go from a third degree heart block EKG reading to a first degree heart block EKG reading, that means something has changed a lot.

What do ya'll think?

Best Regards,
Sandra

2 Comments

Rate Response

by ElectricFrank - 2008-07-10 02:07:59

Sandra,
Interesting! The change from DDDR to DDD mode turned off the rate response even though the cardio said he wanted it left on. My guess is that he doesn't understand the meaning of some of the settings.
DDD mode disables the rate response (at least on my Medronic). However, my printout still shows rate response settings which have no effect. I had the same issue with my cardio for the few checkups after I had the pacer set to DDD. He kept asking the rep to adjust rate settings. The rep was trying to be diplomatic and changed the settings.
I suspect
You have the right idea about the meds. They are a downhill route.

AsVs = 1% Atrial Sensed Ventricle Sensed
which is no pacing
AsVp = 85% Atrial Sensed Ventricle Paced
This is the mode you need for AV block
ApVs = 0% Atrial paced Ventricle Sensed
ApVp = 13% Atrial Paced Ventricle Paced
This is the rate response mode

My guess is that with rate response off the AsVp will increase and the ApVp will go to near zero. Don't be concerned if the AsVp goes up to near 100%. It is just picking up the 13% ApVp.

My suggestion is to give these settings some time and see how they feel. Turning off rate response may take care of both the uncomfortable beats and the highly variable HR. Start exercising and try to stay under 130 most of the time. Once you get used to it then try an occaisional push past 130. It won't feel good when it starts skipping beats to enforce the limit, but now you can tell the cardio that you need it increased. The same may happen with your lower rate of 60. As you get in better shape your resting HR may start trying to go under 60. Then it is time to have it decreased to 55.

I'm glad things are going well.

frank

Shocking adjustment.

by Pika - 2008-07-11 08:07:28

Every morning when I open up my eyes (still in the bed), my heart is running like an express train. Later on my heart beats like a metropolitan train, stops all stations. Run........Stop, run..........stop, keep going like this. I'm exhausted, SOB, light headed (dizzy), and then chest tightness. Then I hook on a holter monitor to see what's that - express train. The result was coincident with ventriclar pacing. The ER doc told me that it is called pacemaker syndrome.

Well, I told my EP that I want to turn the pacemaker down. Begging for 1 whole year, Ok - put it at 65. He said set to sense the ventricle, pace if needed. One year later, went in for interrogation. First time asking the report to keep. Went home have a look - ........! Ventricle paced >99%! Not a joke, it was shocking! He told me the year before only paced 83% but I didn't know was pacing Atria or Ventricle though. I'm wondering the setting is correctly being set or not? I hope he is not playing on me as a doll!

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A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.