Reducing RV pacing?

My first post so greetings! I'm 64 with ICD implant in 2009 for sustained VT. A few shocks and "terminated episodes" post implant but thankfully the VT has subsided with amiodarone treatment. Earlier this year generator was replaced with Boston Scientific Enogen EL initially set to DDD mode.

Prior to the gen changeout I was having issues with occasional light-headedness. Turned out it was pacemaker syndrome. During these v-paced instances my systolic BP dropped from 110 avg. to 70 when standing. Went back to EP and underwent a series of adjustments that unfortunately resulted in PMT (probably caused by lengthening the AV delay) and landed me in the hospital with syncope. All pacing parameters on the ICD were "reset" with good success. No more PMT and down to 4% ventricular pacing. As I'm very sensitive to v-pacing and wanting to reducing it to a minimum the Boston Scientific tech put me in Rythmiq (AAIR DDDR) mode switching akin to Medtronics MVP. No improvement though (except for the rate response that works great!).

Am I unrealistic to hope for eventually getting to a <1% or so ventricular pacing being that I'm experiencing a significant BP drop when it kicks in? I can live with what I've got (and be very grateful it's not worse) but if there is a chance for improvement I would like to go for it.

2 Comments

re: Reducing RV pacing

by John@PC - 2015-10-24 02:10:32

Thanks Dave for a bit of a reality check. When I first got my ICD the only time I experienced v-pacing was when the tech would do a "speed-up" to check leads. About two years ago I started noticing isolated pacing (a few beats at a time) but thought they were pvc's. They have become more frequent and seemingly harder to control.

You mention AAIR: that's one suggestion my EP made but the Boston Scientific guy wanted to try the mode-switch thing first. When I go back I'll ask my Dr. if AAIR is still an option to try and let you know if we go that route.

<1% VP

by Good Dog - 2015-10-24 12:10:19

I'm just taking a stab at this, because I think this is definitely a question for the BS Tech or EP Doc.
I do think that it is unreasonable to expect less than 1%. I am not a doctor and don't really know crap, so please take with a grain of salt. I have read and experienced that VP doesn't decrease in time. Quite the opposite seems to be true.
Something else very interesting that I've read: AAIR (atrial rate adaptive) pacing may be preferable to DDDR (dual chamber rate adaptive) by avoiding an abnormal ventricular activation pattern. However, I don't think you have any control over that. You should ask.

Could be that a CRT or Bundle Branch Pacing would be beneficial. Don't know if that is possible with an ICD. All good questions to ask if you haven't already.

Wishing you the very best!

Sincerely,

Dave

You know you're wired when...

You get your device tuned-up for hot dates.

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