Okay pacer reps/docs, whats up with that?

I had a Medtronic Reveal removed and a pacer put in. My Reveal showed episodes of bradycardia, 30, that led to syncope. Now that the PM is in my doc wants me to relax and will not share my settings with me (yet, he says). I went in to have the PM placement checked (leads moved). While there the rep interrogated me. I swear I'm having short runs of V/T. The tech showed something important to the doc. The tech said the PM did not record any A/T. Doc asked me what my Reveal rate setting was for detecting A/T. I told him A/T was at 155 or 165.
My suspicion is that the PM is detecting VT.
My questions are: If I have A/T at 158, and the PM setting is to detect at 170, it will not record A/T even if it is A-fib, correct?
Second, if I am having short runs of V/T, does the pacer do anything but watch?
Real technical question: During V/T is the S/A node firing?
If not does the pacer not pace because it senses the ventricle firing?
I shoulda been an EP...I'm so curious!

9 Comments

What the hell kind of quack are you seeing?

by PacerRep - 2013-10-25 11:10:20

He won't tell you your settings? That is utterly absurd.

Your pacemaker will record any Atrial Tach that is above your upper tracking rate. It must start with a non physiologic Pwave to be considered an A-Tach (so running on the treadmill and getting your HR up to 158 won't trigger it to record).

The pacemaker only records V-Tach, there is nothing a regular pacemaker can do to stop that...Defibrillators have a feature that can intervene if it's a true VT.

The answer to your SA node firing is....Maybe. If you conduct Retrograde it will be suppressed....If your heart does not have that ability, then your SA node will fire since it will never achieve systole from the VT.

Question to PacerRep

by Casper - 2013-10-25 11:10:39

I was hoping you were going to jump in here.

If she's on the treadmill and her HR goes up to 158, how come it won't trigger to record.

How does the pacemaker know she's running on the treadmill and not to record it.

Please excuse me, if this sounds like a silly question.

Casper

?

by Casper - 2013-10-25 11:10:55

You've mentioned before your doctor wants you to relax, but why can't he reveal the settings to you and further more you should insist on seeing these settings.

You've raised some excellent questions, it seems to me that during V/T your Sinus Node in indeed firing, it's the A/V node that's not receiving this signal.

You should insist on getting a detailed copy of the report and eliminate the guessing game.

I don't think it would record any A/T if the settings are 170, I hope others will jump in here.

But....please get a copy of your records for your own piece of mind.


Casper

asfasf

by boxxed - 2013-10-26 01:10:59

Exertion is 1:1. If it's 1:1 then it simply comes down to rate, which PMs are not typically programmed to detect a rate that low.

If there are instances where there are more A's than V's at a given moment, the device will consider it an atrial tach and start recording.

What are you waiting for?

by Casper - 2013-10-26 02:10:24

If I were you, I'd call the office on Monday and get a copy of the last report, there's not harm if that.

Who implanted the pacemaker for you, I hope it was the EP.

Casper

Thanks

by Danise - 2013-10-26 02:10:25

Thank you all for your input. I will get a copy in January for sure. I think he should tell me if the PM is recording VT. Even if they are short runs. I don't know if its ego or ??? preventing him from referring me to an EP. Time will tell.

Why VT?

by golden_snitch - 2013-10-26 04:10:42

Why are thinking that you are having short episodes of VT? I mean your Reveal never recorded that, and you do not seem to have any history of tachycardia. I don't get it. No history of that at all, and then you think you have the worst arrhythmia that's possible? How do you know how VT feels, if you never had it before? I really don't understand it.

Afib will be detected because it's much higher than 170bpm; Afib is anything faster than about 400bpm in the atria. It's therefore an atrial high rate episode. So, for sure, Afib will be recorded.

Inga

Casper.....

by PacerRep - 2013-10-26 11:10:24

The pacemaker classifies arrhythmia based on chamber of origin (if the first beat is in the A or the V) and the rate of acceleration. In your treadmill example, your heart will "warm up" and take a while to to get to that 158....this is considered a physiologic response and the pacemaker is told it is normal and don't worry about it. SVT's, Flutters, Fib's, Junctional's etc etc etc, they all start much faster and the pacemaker is told to flag that when the heart rate changes too fast to be a physiologic response.

This goes the same for when the arrhythmia breaks, it doesn't slow down at all.

ICD's have a more sophisticated approach since it matters much more in these situations, but that's a whole nother conversation and would take all day.

Thanks!!!

by Casper - 2013-10-27 12:10:26

Hi PacerRep,

That makes sense, thanks for the feedback.

I learn something new every day here.

Casper

You know you're wired when...

You can finally prove that you have a heart.

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