58 day Biotronik Report from ANDREw75

BIOTRONIK REPORT FROM 12-11-2023 TO 2-7-2024 (WITH FLECAINIDE)

58 DAYS. Key points noted.

 I feel much better with no symptoms from the medication. I can take deep breaths and have no dizzy spells on exertion. I have no trouble exercising and feel vital again. The only drawback is with High Intensity Cardio since my CLS settings are set for 130 bpm max. My EP is reluctant to raise this, and I made a joke to him about not being able to “run for a bus” anymore. He is not from the UK, and I had to explain this to him.    

PVCs                    The previous PVC burden count was 25%, reduced to 10% with this medication, (15% reduction).

PACING              In Atrium pacing increased from 55% to 77%

                            In Ventricle pacing increased from 4% to 6%

Pacing Comment: I wondered why this increase in pacing, and concluded this was due to the PVC reduction. PVCs are extra beats, so if they are reduced extra pacing would be required to make up the same effort requirements. Is this correct thinking?

MY ARRYTHMIA

PVC’s                  99%

Couplets           1%

Triplets               0%

Tachycardia, one small episode 1-10 min

BATTERY:ERI ( Elective Replacement Indicator). Ref: Natalie Battery comments.

With this extra pacing the battery life estimate was reduced from 9 Yr-9 M to 9 Yr-3 M.

This is a  6-month decrease in battery life, probably due to the increase in pacing and the extra power needed.            

OXIMETER & BP Monitor:  Now seem to be reading OK, and the PVCs are not causing mis readings, but this is minor observation, and I did not mention this to my EP or Tech since it’s not very scientific.   

A great report for a 75-year-old, I am going wind surfing.


6 Comments

Report

by piglet22 - 2024-02-20 05:27:33

Good stuff.

This sort of report should be routine.

I've never had one in 19 years. Never offered and minimal feedback from the technicians.

Yes, you are quite right on your thinking. PVCs get sensed and counted in by the PM and reduce the PM pacing rate. If your ectopics are reduced by medication (Bisoprolol 10mg daily in my case), PM activity will increase to more like what it should be.

It's why they always say the PM is fine which is technically correct, but functionally incorrect.

Of course this will reduce battery lifetime though figures extrapolated years ahead come with accuracy warnings.

However, reducing the effects of PVCs through the medication route comes with it's own problems.

Hills that I could cycle up 18 months ago, I struggle to walk up. Aching limbs are now the norm. Running for the bus would be out of the question.

So lack of energy is the price paid for not blacking out.

I'm due to see the pacing consultant in a week's time and already have the questions written down.

Not happy that all contact even with old PM and deteriorating condition has been reduced to an annual download and no feedback.

Thanks for posting.

PS

Totally concur with the comment on oximeter and BP monitor performance.

They work well with "normal" conditions treated by PM, but certainly struggle with complications like ectopics. What they do do is give an indication that something is going on, but not necessarily accurately.

 

Flecainide seems to be suiting you

by Gemita - 2024-02-20 06:51:20

Andrew, thank you for your post, full of interesting details.  I see that you are only having PVCs 10% of the time now (during a 58 day period of monitoring) and that PVCs made up 99% of your arrhythmias seen + PVC couplets, 1%, with only one short tachycardia episode picked up lasting no longer than 10 minutes.  Sounds excellent, although I am unclear how they calculate your PVCs?  Mine are shown as PVC Runs (2-4 beats) per hour, or PVC Singles per hour, not as a percentage figure over a period of time.

I am so glad Flecainide is suiting you and more to the point is helping with those ectopic beats.   Your increase in pacing is not significant and could be due to many different factors, including the new medication (Flecainide slows conduction through the AV Node), pacemaker settings, lifestyle, other health conditions and certainly changes caused by any increase or decrease in rhythm disturbances like PVCs.  It will be difficult to pinpoint the exact reason for the increase in atrial or ventricular pacing, but what is important is how we feel, not those percentages and you certainly sound as though you are feeling really well at the moment on Flecainide and that is what really counts

PVCs Reduced

by ANDREW75 - 2024-02-20 17:58:12

Hi Gemita, thank you for your comments. After your post I felt compelled to compare my three reports.

Biotronik expresses PVCs as a percentage of the total Event Episodes and Events. They provide three Event counter graphs, ATRIUM, VENTRICLE, AND BOTH:

Below are the figures from BOTH:

As-Vs                   17%

As-Vp                  1%

Ap-Vs                   69%

 Ap-Vp                 3%

PVC                    10%

The sum of All these Event Episodes is added up to 10,126,199. It shows this is the total count over the  58-day period.

So for 3RD Report total event count would be 174,589 per day

10% PVC would be 17,458 per day OR 727 per hour

 

                  1ST REPORT                    2ND REPORT                     3RD REPORT (FLEC)

DAYS                13                                       39                                           58

PVC %              28%                                    25%                                       10%

PVC/HOUR    1303                                   1122                                        727

 

I see a definite improvement since I had my pacemaker last August.

Bit Confused

by Penguin - 2024-02-21 06:34:11

So you have no PVC triplets - just couplets - (2 in a row). I forget, were they symptomatic?  Presumably your EP felt that couplets and single PVCs justified Flecainide or were there longer pauses before you took the drug? 

Your device counts couplets and triplets - that’s good. Would you or anyone else happen to know whether or not all devices provide these statistical breakdowns by PVC type? 

What would it mean if you had PVC triplets Andrew and they weren't counted, or four PVCs in a row?  Is it the number of consecutively missed beats that raises concern or the overall burden of PVCs? 

Your advice would be helpful if you know the answers to these questions. 

PVC confusion.

by ANDREW75 - 2024-02-21 11:32:30

Hi Penguin,

I have always had single PVCs and am on Flecainide just for them. The other arrhythmia Events are considered insignificant. I have always had too many PVC’s even before my pacemaker. I have never had symptoms from PVCs except lack of energy and being puffed out occasions.

I would imagine if you had double or triple PVC events occurring it would be more troublesome, especially if you had a high percentage of them.

I have a Biotronik pacemaker and most of the charts and graphs are percentage over time, which makes sense so you can compare interrogations. The reports are 40 pages long and very extensive.

I don’t think “consecutive” missed beats is the issue so much as the number of “interrupted” beats over time.  

By the way PVCs were my secondary issue to Bradycardia. 

Hope this helps.

Thanks

by Penguin - 2024-02-21 18:55:24

Thank you for the information.  I had wondered about feeling puffed out and have never had a great explanation for it. I'd assumed RR was responsible.  

Those reports sound useful. There are a few people on here who could do with similar PM generated reports. 

It's amazing how much information can be generated when requested isn't it?

You know you're wired when...

You have a dymo-powered bike.

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