Defibrillator activation

My pacemaker was placed Aug 2023. It is a Medtronic CRT-D. 
Last Wednesday I was getting on my exercise mat to do morning stretches. Just got on my back when I experienced a shock which I initially thought was my demise! What a feeling. 
As recommended by my ep doc we called 911 and got transported to the local hospital. After several tests, ecg, xray, bloodwork etc. they checked my pacemaker memory and determined that the defib was triggered by ventricular tachycardia. 
I have talked to my doctor that placed the unit and got some info but I need to get appointments with the ep lab and cardiologist. I n the mean time I am on edge that it could happen again at any minute. 
the doctor said that they may be able to program the activation differently to try and minimize the occurrence. Also he may recommend an ablation and amiodorone in addition to all my other meds. 
Any advice or information would be appreciated. 
Bob 


2 Comments

Shock

by Old male - 2024-03-17 00:31:58

Diagnosed with Ventricular Tachycardia is why I have an ICD.  I've had 2 shocks (Therapy) in 10 years.   Both times It was over before I had a chance to realize what happened.  Started suddenly to pass out then Zap.  Wasn't really painful but more of a Startling event.  Realize it possibly just saved you from Cardiac Arrest.  Thank God for the technology.  Life goes on.  

I hope they can minimise future shocks while keeping you very safe

by Gemita - 2024-03-17 05:30:32

Bob, firstly, I am so very sorry to hear about the shock.  I cannot imagine how difficult this must be for you not knowing when this could happen.  

From your comments, the pacemaker clearly did its job and identified a dangerous arrhythmia.  It looks as though the defibrillator was super sensitive in picking up the ventricular tachycardia (VT) though - certainly from your doctor’s comments “that they may be able to program the activation differently to try and minimize the occurrence”.  This suggests to me that the defibrillator may need some fine tuning to make it less sensitive, although clearly it needs to be sensitive enough to prevent a dangerous arrhythmia like VT from taking hold.

Your Bio doesn’t tell us much.  Do you have other arrhythmias, like atrial ones which might possibly need more in the way of control?  Sometimes we can get “inappropriate” shocks from other arrhythmias that are coming in fast, that might be a trigger for runs of ventricular arrhythmias, so I would ask your doctors what they meant by trying to minimize the occurrence?   I cannot imagine they would make your defibrillator less sensitive to picking up “sustained” VT but they might make it less sensitive to picking up for instance, atrial tachyarrhythmias, or perhaps "non sustained" VT. 

As you probably know, sustained VT is defined as an arrhythmia that lasts for more than 30 seconds at a rate greater than 100 bpm, or which leads to hemodynamic compromise within 30 seconds and requires intervention. Non-sustained VT  lasts less than 30 seconds and generally doesn’t cause hemodynamic (blood flow) instability. 

If you have other arrhythmias as well as VT that need controlling, like atrial tachyarrhythmias, Amiodarone can be an effective medication.  Although Amiodarone can come with some serious side effects and needs close monitoring, doctors usually like Amiodarone because it can work when other meds fail.  An ablation would be more invasive than medication but is often more effective.

If we can better control your VT by whatever means, there will be less likelihood of receiving a shock in the future, so this is why they are looking at every possible option.  Are there any support groups in the hospital?  I would ask, since controlling your fears is as important as controlling your arrhythmia burden. I wish you well and hope that your doctors will continue to keep you safe.

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