Histograms

Hello, all!

It has been a long time since I have posted on here, but thought I would see if anyone could offer some insight.

I have a dual lead Medtronic Adapt, ADIR mode, lower limit set to 90 to out pace the junctional tachycarida that I have been experiencing for years. I have sleep mode on, lower limit set to 60. They made these changes last friday, and I was feeling really great, but then monday I started to experience what felt like pvc's/pac's.

Went into the pacer clinic, and the histograms were very strange. In ADIR mode, the V lead is off, but still senses to show activity. Well in the A I was paced 70% of the time, 35% of the time at 90 and 10% of the time at 100 and then the rest was a very minimal percentage from 60-130 bpm. 20% of my beats were sensed at 60 bpm (sleeping). It reported 371,792 total beats in the three days since they made the changes.

In the V (remember, just sensed) It showed that about 70% of beats were at 90 bpm and 20% at 100 and the rest were >5% from 40-150 bpm. It reported 181,085 total beats on the three days since they made the changes.

SO... My first question, what would cause such a discrepancy between the total beats in the A and the V? Quick math shows a bpm average of 86 in the A and an average of 42 in the V.

My second question is, are these measurements (total beats) accurate? I understand the bar graphs used for the histograms can have a slight margin for error, but beat count should be accurate, right?

I am waiting for my EP to call me back. When I saw my general cardiologist today, he literally said 'I have no other explanation other than it must be wrong'. That is a BIG number to be wrong about!

I appreciate any insight-- I have tried to research online but have not come up with much.

3 Comments

Thanks Donr!

by BrynaR - 2016-03-30 01:03:16

Thank you for your comment, I appreciate the time you took to read my previous post and the time considering what could be going on :)

My EP got back with me about the histograms and his assumption is that when I was in sleep mode, my AV delay was so short, due to my intrinsic rhythm being an ectopic atrial rhythm (the focus being right by the AV node) that the pacer isn't able to 'see' the ventricle beats. He turned off my sleep mode to keep me 100% paced and the histograms now match up.

During our conversation, he said that since this setting is helping me feel better, the next step would be an ablation of the ectopic atrial focus (NOT the AV node) so that I can be paced at a slower rate. He said he's not advocating this, but it's the next step. Given my history, I'm having a hard time deciding what to do!

A late try

by donr - 2016-03-30 04:03:39

Bryna: I've been reading your post w/ interest for 7 days, now, expecting someone who knew something to answer. No one did, but I'll try anything - usually more than once!

I've read your history & all of your posts/comments.

I'm going to have to make a bunch of assumptions & uess a bit, so here goes!

1) You said: "Well in the A I was paced 70% of the time, 35% of the time at 90 and 10% of the time at 100 and then the rest was a very minimal percentage from 60-130 bpm. 20% of my beats were sensed at 60 bpm (sleeping). It reported 371,792 total beats in the three days since they made the changes."

2) I have a Medtronic PM, also, so I dug out an old download report to refresh my memory. It appears to me that you are mixing data from TWO locations - the page that lists all the combos - AS - VS, AP - VP, AS - VP & AP - VS & the histograms. The area under the histograms always adds up to 100%, but you have to do a lot of adding to get there because each decade of HR's has two components - paced (Black) & sensed (White). The page that lists the combo's also add up to 100% - again the four categories add to 100% If you look only at the Atria data - That means the Two combos w/ AP total 70 % & the two that contain AS total 30 %. I submit the following hypothesis - On the Histogram there are WHITE components of Atrial SENSED beat that do NOT show up because they are LESS than the BLACK components. You have 35% PACED at 90 BPM. You could well have another 35% SENSED bets at 90 BPM that would not show because they are blanked by the 35% BLACK Paced bar. I've just accounted for ALL of the missing beats that were sensed.

3) You said: "SO... My first question, what would cause such a discrepancy between the total beats in the A and the V? Quick math shows a bpm average of 86 in the A and an average of 42 in the V."

4) It appears that your SA functions about 30% of the time. After re-reading your history & discussions w/ Inga, I sense that you have some heart blockages. Inga discussed the parameters of Medtronic's algorhythm for minimizing V pacing. I noticed that your V is not paced - but is it possible that your MVP algorhythim is NOW switched ON and you are having a significant number of AV blocks, meaning that your Ventricle beat count is LOW?

Be interesting to hear what your EP says.

Pls keep us informed.

Donr


Something doesn't ...

by donr - 2016-03-31 03:03:59

...pass the common sense test for me. Worst part is that I'm not sure of what it is. (Or is NOT.)

I think that here is where the disconnect lies - Your EP is a great, talented Cardiac specialist, but NOT an Electrical Engineer. I am a half - baked EE who spent many yrs using basic EE Principles & common sense analysis on complex problems to get solutions or explain what was going on. But I am an even worse cardio.

My current hypothesis is that he is correct in his actions, but wrong in his explanation for the cause of your last week's experience after he changed your settings.

This is going to take some analysis during that transitional, semiconscious period that exists between sleep & awake, early in the AM, when the mind free-wheels and can analyze in multi-dimensional space.

It may take a day or two for my mind to enter that state, since I cannot command it to do so. It only senses when I am troubled by something complex & will take command to look for a solution.

Like Arnold Schwartzenegger in "Terminator I," "I'll be back!"

Meanwhile - I wish you the very best & may your EP continue to make correct decisions.

Donr

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