Smitty and Tracey....I am still confused!

Sorry, I don't quite get the settings. I think I get the lower setting.
BUT..the high set point.....is that the one that they set at like 170 and if your heart beats to fast it will slow it down? I thought thats what the dual chamber did.
I have sick sinus syndrome.My biggest problem is that at rest...this includes any time I am not actively moving..my HR is around 34...and pretty much stays there until I get up and move or get upset....something to raise it. It then stays at a good rate..60s to 80s. HOWEVER if I go jogging or exercise..it will shoot up to 170-180 in one minute..and I feel like I am going to pass out..and get short of breath.
So the doctor was going to put in a dual chamber PM.
Then he mentioned I would only be getting a single lead as it was less "hardware". I asked why..he said since my PRIMARY problem is sinus brady....the single lead will take care of that and he can use BB to correct the tach when I exercise.....MY THOUGHT is why make me take meds when you are putting in a PM in anyways? But I'm not the doctor.

If I am understanding you right..thats what your wondering too?

He is suppose to call me...but no call yet.

So back to the settings.....the high setting is the one that your HR should not go higher than..like say..170 for me?

Sorry for all the questions....I know it wont be right the first time..well may not be....but I would like not to leave with FACTORY settings and wait on them to fix it.

Thank You Holly

10 Comments

Thank You Tracey

by LIVE_STRONG - 2008-07-22 10:07:18

I am starting to understand. I will ask him when he calls about the second lead. I asked once...but it doesn't make since to me either not to just put it in case I need it...cause I do not want BB.
ONE of my biggest problems..is chronic fatigue!

Thank you so much!

Holly

settings

by Tracey_E - 2008-07-22 10:07:29

minimum is the hr that you cannot go under. Mine is set at 60, so no matter what happens my hr will never go under 60. If my natural atrial rate drops to 50, the pacer will kick in and make sure I stay at 60.

(an aside because you seem concerned the min might be too high... my rate was in the 40's all my life, dropped to 30's then 20's prior to first surgery. 60 was double what I was used to but it did not feel fast. It felt wonderful and I was energized, all that extra oxygen!)

maximum is how fast the ventricle can pace the atria. I am set at 170. So if I'm working out and my atrial rate gets up to 200, the pm will not put my ventricular rate over 170.

When your heart is beating more normally (pacer assisted) you will likely find that you no longer shoot up so quickly but instead get a steady increase.

Yes, I was questioning why not get the dual chamber. It's not that much more hardware and if there's even a remote chance of ever needing the second lead, you'll already have it. If it were me, I would push to try to fix the secondary problem with hardware rather than meds. No side effects and easier to control, but it may not be that easy because I'm not familiar with your problem. But yeah, if it were me, I'd be asking more questions about why he decided not to do the second lead.

1 lead - 2 lead & meds

by Vai - 2008-07-23 01:07:14

Think of it this way. You gave 2 problems - brady and tachy condition.
1st lead connects to the atria. When heart is too slow the PM will support your heart to the low setting, say 60 BPM. The ventricle will beat in synchrony with this rate. Solves your brady problem. You won't feel this.
2nd lead connects to the ventricle. When your exercise, your heart rate "shoots" up to 200 BPM - really no good. The PM will intervene and interrupt your natural heart rate to "regulate" it down to the high setting, say 170 BPM. This is really very uncomfortable and unpleasant experience. You really feel this.
This is why doctors prefer to treat the tachy condition with medication so you will never get to experience the second condition (hopefully).

Hope this helps. Best of luck in your decision.

Thank you vai and Tracey....

by LIVE_STRONG - 2008-07-23 02:07:03

I think I get it now....what alot to wrap your head around!
But it is getting much clearer now.
thank you,
Holly

awake/asleep

by Tracey_E - 2008-07-23 02:07:25

Most pacers are done while you're awake! Mine is really deep and they put it in from the side (about where an underwire hits) so they used a general.

Fatigue

by Tracey_E - 2008-07-23 07:07:48

Of course you're chronically tired, your hr drops into the 30's when you sit down. That should all be history soon! I was in the 30's all the time the last few months before I got the pm, constantly dizzy, constantly tired, so out of it I didn't even think to mention to my doctor how bad it was. For me, getting that minimum rate up in the 60's was like chugging several pots of coffee. I felt amazing and couldn't stand to sit still from the time the anesthesia wore off. I'm wishing you a similar experience.

I'm looking forward to hearing from you next week, when this is behind you, when you say how great you feel and how all this worry was for nothing. {{{hugs}}} It's good to understand what's going on with your body and what's going to happen, but it's also important to focus on how good you're going to feel and have faith in your doctor to take care of you. That's why you're doing this and chose a good doctor- so you feel better.

Frank's right

by Tracey_E - 2008-07-23 07:07:56

Pacers keep up (when ventricle doesn't beat when the atria does) or speed up (when you go too slow on your own), they don't slow down your natural rate. If your atria does 200 when you're working out and your ventricle naturally keeps up, the pacer can't stop it and your hr will go up to 200. If the ventricle is dependent on the pacer (which is what I talking about), the pacer will only track up to the set max. Me, I'm 100% paced on the ventricle, so I occasionally run into problems bumping my upper limit when I'm working out, atria hits 180+ but ventricle is only programmed to 170. Sounds like that will not be a problem for you.

Tracey...Thank you so much!

by LIVE_STRONG - 2008-07-23 11:07:27

I feel so much better now.....I think I am understanding it now.
I am still waiting on that phone call from the EP. I still have to wonder why he is not going ahead and putting the dual chamber and two leads in....it does not make sense.
I don't want to go through all this only to be put on BB and be tired again.
I take BP meds (norvasc) right now....that makes me tired enough!
Oh well....your right...I will be back next week telling you how great I feel!
Anesthesia???
I was told I will be awake. Then again I don't tolerate anesthesia well either. He said he wold just use LIDO and numb me real well..which is fine with me. I don't care as long as all I feel is pressure. I have had to stay awake for surgeries before.

God Bless.....I am sure I will have another question before Friday..LOL.
The waiting and thinking about it .....is hard..

((HUGS)) Holly

Frank.....

by LIVE_STRONG - 2008-07-23 12:07:02

Are you saying that since it is a single lead....I wont have an upper limit?

Because thats what I am confused about...I thought I would only have a lower limit and it would kick in should drop below it.
??????
Thank you ...Holly

Correction

by ElectricFrank - 2008-07-23 12:07:08

Tracey,
I agree with most of what you are saying, but the ventricle can't pace the atria. There is no pathway for that and it would be a serious problem if there is. The sinus pacemaker paces the atria and the atria paces the ventricles. The electronic pacemaker can't slow atrial pacing. If the artrium is being paced by either the sinus node in response to activity or some arrhythmia like afib the pacer can't stop it. The same is true if you have a normal AV the ventricle will follow the atrial beat no matter what the electronic pacer does. What I am saying is if you implant a pacemaker in a person with normal heart function and they exercise to 200 BPM there is nothing the pacer can do about it. However, the pacer can always enforce a lower limit by adding beats.
Usually the upper limit is used where either rate response is on and it sets a limit on how fast the pacer can drive your HR, or if there is an AV block and the pacemaker is used to transmit atrial pacing to the ventricles the it can enforce the upper limit by skipping beats (an uncomfortable situation).

I hope this isn't too convoluted! I got carried away.

frank

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