ATP (Antitachycardia Pacing)

Does anyone have a good understanding of this feature ATP, not APP (Atrial Preference Pacing) ?
I have a Medtronic Revo MRI RVD01. Today, my EP asked me if I want this ATP feature to be turned ON after interrogation because she mumbles that I have a bunch of tachy episodes in the past 6 months. I said obviously "Yes" and shouldn't it be "On" at the first place? Why did she NOT turn it on at the first place and now ask me a stupid question like that and let me suffer for past 6 months?

Does anyone know why that feature shouldn't be "On"?
I mean don't we want the PM to give us therapy when the heart goes into tachy? This is rather odd and ignorant in my EP and Medtronic rep, I think.

Anyway, I tried to look it up in Medtronic website to get to the programming features, but I couldn't find it. Does anyone have a good knowledge of this feature and/or direct me to the right place for information and its programming variables? Thank you so much.

Have a nice day.

Duke

5 Comments

Wait and see

by Theknotguy - 2014-02-14 10:02:23

Duke:

Thanks for alerting me to APP. I got my EP to turn it on for me. So your insight has been a great help. As for ATP I'll give you two websites I found on the Internet.

http://www.medscape.com/viewarticle/490543

https://circ.ahajournals.org/content/104/7/796.full

The second site says,
"Background Implantable cardioverter-defibrillators (ICDs) can terminate some ventricular tachycardias (VTs) painlessly with antitachycardia pacing (ATP). ATP has not routinely been applied for VT >188 bpm because of concerns about efficacy, risk of acceleration, and delay of definitive shock therapy. This prospective, multicenter study evaluated the efficacy of empirical ATP to terminate fast VT (FVT; >188 bpm). "

I'm thinking your EP didn't turn it on because they had to wait and see if the APP would take care of the problem. Heart doctors believe in the adage - If it ain't broke, don't fix it. If they mess up your heart you might not make it back to complain. But your relatives may sue. They also sometimes go the minimum because if they turn on features and you still have problems, it leaves them with no options. And sometimes, the more features they turn on, the worse you'll feel.

I ran into that situation a couple of times while my body was adjusting to the new reality. It's pretty grim when they say, "We have one more option. If that doesn't work, you'll need to make final arrangements." I'm telling him, "Yeah, doc, let's hold off on the one-more-option." I don't really get into that position where just one more white shirt will do it for me.

Thanks to your comments, I had the APP turned on on mine, but I've gone through two weeks of getting readjusted to how the PM is ordering my heart around. I sometimes get the feeling of, "Emma! It's the big one!" Then have to wait a few seconds until my brain figures out I'm really going to live.

Also when my EP turned on the APP he tried to turn on another setting and the Medtronics programming wouldn't let him do it. Either that setting was combined in the APP or the two settings would conflict. Don't know which. And I really didn't want to sit there while he called Medtronics to see what was what. You already said APP worked so I wasn't going to argue.

So I'm thinking with the hundreds of different possible combinations and permutations they have, EP's won't know as much as they'd like about the PM's. My EP supports Boston Scientific, Metdronics, and St. Jude. About 33% for each. That's a lot to keep track of and when you throw in the millions of possible combinations for human patients, I really don't see how they keep up as well as they do. So I'm thinking it isn't personal. It was more of - let's keep our options open.

So, yeah I know it's frustrating. But hey, we're still alive to complain. So I guess it isn't too bad.

Hang in there. Life gets better.

Theknotguy

Medtronic EnRhythm Pacing System

by Roys - 2014-02-14 11:02:44

Hi: My EP took 3 months to switch on my Overdrive Pacing for A-fib, they don't turn it all on at the same time. If you e-mail Medtronic and ask for info they will send it to you, I got over 60 pagers. The EnRhythm Pacing System offers a tiered approach to restoring sinus rhythm in patients with atrial tachyarrhythmias.
Cheers Roy

Thanks

by Duke999 - 2014-02-15 04:02:08

Thanks for your reply.

Theknotguy, the links you provided are for ICD, but I think the algorithms work the same for pacemakers. This feature helps to eliminate unnecessary shocks for people with ICD, which is a good thing.

Roys, I'm glad to hear from you. It's been a while you posted. Are you still doing supplements? Any changes?
The Enrythm pacing system is another model type from Medtronic with similar pacing therapy. Thanks for sharing.

Golden_Snitch, your insight always amazes me. Thank you so much for sharing your thoughts. What you said kind of make sense, but also confusing like heck. I finally got the link to the manual which explains everything about the parameters of these features. I have to tell you, it's so complex that I got a headache trying to follow. I think I need to school for this. Its algorithm is so complex. By the way, do you understand all of the features? Are you a professor, engineer or scientist or something?

I wish you all well.

Duke

Reactive ATP

by golden_snitch - 2014-02-15 04:02:36

Hi Duke!

You just don't turn each and every feature on, if there is no evidence that you need it - every feature drains battery, especially antitachycardia therapies. So, it was correct to wait and see, if you have tachy-episodes running at rates where switching the ATP on might help. This was not odd or ignorant.

"Reactive ATP" is anti-tachycardia pacing for the atria, not the ventricles in this case. A Medtronic rep told me that it basically only works for atrial flutter, not for any atrial tachycardia that is running rather slow. With "slow" I mean atrial tachycardia where the atrial rate is, let's say, below 180-200 bpm. The rep explained that this ATP feature only works for atrial tachycardia where you have a pattern of at least 2 atrial impulses per one ventricular impulse. This is typical for atrial flutter, but not for AVNRT or WPW syndrome or ectopic atrial tachycardia, those usually have a 1:1 pattern. In addition, the episode needs to have a certain length. In the manual you find:

- There are at least 2 atrial sensed events per ventricular interval for a sufficient number
of ventricular intervals (at least 32 ventricular intervals must have passed since the
beginning of the episode).

- The median of the 12 most recent sensed atrial intervals is shorter than the programmed
AT/AF (or Fast AT/AF) interval.

So, obviously this feature is not for everyone. If you have atrial tachys that run at 120-160 or so beats per minute, ATP won't be able to do anything at all. The detection zone it has for atrial tachy-arrhythmias starts somewhere at, I believe, 170bpm. Also, Medtronic warns that ATP should not be switched on before the atrial lead has matured. So, no, this feature is one that cannot be activated right from the beginning.

Inga

Supplements

by Roys - 2014-02-15 05:02:10

Hi: Yes I am still on my supplements and doing ok, no changers.
Roy

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