Outputs and AV delay

Hi -this is a follow up to my post on Monday, and thanks to Smitty for his advice (hope you received my note).
Now have a copy of the report from the cardiac physiologist - apparently in order to minimise ventricular pacing she "turned the outputs down and turned of the AV delay". HR was 43bpm so she was in touch with my GP and my metoprolol has been reduced. Hopefully I will now be able to walk up y back yard steps again!! Unfortunately I seem to be extremely sensitive to ventricular pacing - always was very aware of the ectopics and pauses etc before the pacemaker.. Can anyone help with telling me what the change in the settings above can mean?
Thanks
Maureen

7 Comments

PM Settings

by SMITTY - 2010-12-09 11:12:28

Hi Maureen,

Yes I got your message and poking a hole in a vein makes more sense that hitting a nerve. Although I never had any doubt that was what your Daughter was told. I've seen too many times where hospital personnel will tell us something they think will put our minds at ease rather than tell us something that may bring on more questions.

As for the vein they punctured, if it is the one they run the leads through from the pacemaker to the heart it is called the great vein and is about a half inch (12.7 mm) in dia. So a hole in that one could cause the loss of a lethal amount of blood in a short time.

I can't answer your questions about the new settings but maybe Frank will be able give you an answer.

Good luck.

Smitty

re PM settings

by Lancashire Lass - 2010-12-10 01:12:51

Hi Smitty - thanks for your note - but I think you may have me mixed up with someone else on the site - I am not the person who wrote in about the punctured vein and the bleed.
I will wait and see if Frank can give me an answer re the settings.
Thanks
Maureen

Settings

by ElectricFrank - 2010-12-10 03:12:33

I think I know what the changes are. There is an AV delay that is used to encourage natural ventricular pacing. It waits a bit longer than normal before pacing the ventricle to allow a natural pace to occur. I had this one turned off early in my pacer career when it became obvious that it wasn't having the desired effect. It felt better when off. I don't see how turning delay off would minimize ventricular pacing.

Turning the outputs down likely means reducing the pacing voltages. Lower voltages will increase battery life and also tend to be more comfortable.

Do you know what the condition is that resulted in needing a pacemaker?

frank

Settings

by Lancashire Lass - 2010-12-10 04:12:37

Hi Frank - thanks for your message.
When the pacer is pacing the ventricle I became symptomatic -their words - really aware of thudding beats, nausea, dizziness etc. at that point I was changed to DDIR with hysterisis and extending my AV delay was looked at but it was at the top limit. This was a number of weeks ago. When they turned it off on Tuesday (I was pacing at the time) I immediately felt much better. I note your comment that turning the output down would be more comfortable - and I am more comfortable.

I was found to have AV block, sinus node dysfunction (minor) and left posterior fascicular block, but I managed for a number of months. I then began having attacks of non-sustained VT. I went to the EP lab to try and ablate - couldn't find the focus. So, needed treatment with flecainide and metoprolol, because of the blocks I needed the pacemaker as the meds would make the situation worse. I have a number of health issues and this was the best way at the moment to deal with the cardiac side of things.

Thanks so much for your explanation, it's great to know that there are people here to help with support and advice.

Smittyzheimers

by ElectricFrank - 2010-12-10 05:12:03

Thats franks diagnosis. Probably a lot like the Frankzheimers I have.

I hope they come up with a brain defib some day.

AV Block

by ElectricFrank - 2010-12-10 06:12:31

Lancashire Lass,
Something sounds strange. With AV Block there is really no getting away from pacing the ventricles. The heart just doesn't work well without it.

One thought occurs to me. You mention being sensitive to ventricular pacing. If you became accustomed to a very low HR like 43 over a period of time, then suddenly restoring normal rhythm via the pacer could feel strange. Adjusting the pacer to minimize ventricular pacing is just a way to cover up the real problem.

This is just my thought without knowing all your medical history, but if it were me I would insist on returning to basics and then add things back. I would ask for using the DDD mode with reasonable upper and lower limits, and unless your BP went way high stop the metoprolol as well(might need to slowly get off it). Then you need to work on dealing with your anxiety over irregular beats, which is almost certainly making BP problems worse.

It is all too easy for the docs to keep adding treatments on top of each other until there is no telling what is causing what. And your reaction to ventricular pacing makes it very easy to be seen as the patient to medicate into oblivion.

If I had succumbed to the original treatment path they were headed for I would be a mess.

I'm not being critical of you or the docs, just honest about what I see.

best of luck.

frank

Another Mistake

by SMITTY - 2010-12-10 09:12:38

High Maureen,

Well don't I have egg on my face now? I'm sorry for the mistake. I'll have to find who I thought I was replying to. My wife has been telling me more and more often she thought I had a visitor living in my head. His name is Al (as in Alzheimer) and I think I see more evidence of that each day.

Makes me realize and I hope veryone else does to, that anything I post here must be taken with a king size grain of salt, of even better, --- now what was I going to say.

Smitty

You know you're wired when...

You can finally prove that you have a heart.

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