Biotronix dual chamber implant and heart pain

So I got my implant last week and until the EP nurse shut down the ventricle lead this morning, I had been feeling a beating pain, like every heartbeat involved a feeling like some little guy was kicking the inside of my heart. So, they shut down the lead entirely and said that since I have good conduction, pacing the ventricle should not add much security to the situation. An x-ray revealed 'some' forward movement of the lead from its implanted position, ostensibly further into the myocardium. So, problem solved for now. But why implant a dual chamber model if a single lead does the trick?

Now, all this was done in the hopes that I could tolerate some kind of beta blocker. Prior to this, a 25mg dose of metoprolol in the midst of an arrhythmic attack would ensure I fall down from orthostatic hypotension. Still does. From lying to standing I lose 40 points of blood pressure with Metoprolol. So they took me off that as well. Going back Monday for another pow-wow. Any thoughts, brave bionic folks?

6 Comments

Ventricular Lead Switched On

by Marday - 2015-12-09 07:12:35

Thanks, snitch:

So the head EP nurse said that there would be a feedback loop closed and I assume she was talking about the CLS. However, interrogation revealed ventricular pacing only 3% while the atrium paced 63% (I am assuming the percentage value to be time). So, her conclusion was that it would be safe for now to shut the lead down.

And indeed, since yesterday my mood and energy have been great. Tasks like getting up and walking across the room; getting in and out of the car, etc. would cause me to pause a bit to recoup. Today, I'm instinctively slowing after each exertion expecting my heart to need the pause and I don't need it.

I imagine I'm in for more interrogation Monday after being off Metoprolol. Nurse was rather matter of fact about the lead maybe poking further into the tissue than it should??

Hey, thanks all for reading

Jeff


CLS

by golden_snitch - 2015-12-09 08:12:23

Hi Jeff,

it can perfectly be that you do not need the ventricular lead much for pacing, BUT you do need it for the CLS sensor to work. If you have been switched to a mode with atrial sensing and pacing only, CLS has been switched off and you are now left with a very basic motion sensor for rate response. The motion sensor will not help with your orthostatic hypotension and fainting at all; only CLS can do that. CLS works only in the DDD (dual chamber) or VVI (ventricles only) mode, not in an AAI (atria only) mode.

Best wishes!

Rate response

by golden_snitch - 2015-12-09 08:12:26

Hi!

You need the ventricular lead switched on, because your CLS rate response sensor only works with the ventricular lead switched on. And you need this sensor, because it helps when you have low blood pressure.

Biotronik pacemakers are often used for patients with orthostatic hypotension or neurocardiogenic syncope. It's because they have this special CLS sensor (closed loop stimulation) that has proven to respond very quickly when the patient has an episode. By bringing up the heart rate very quickly it tries to compensate for the low blood pressure, and normally this works well enough, so that the patients do no longer pass out. They still have some symptoms, but they do not faint any longer.

So, you definitely need the lead switched on, and you might then also need to have your CLS settings optimized to fit your needs. With the nominal settings (factory settings) CLS might not respond quickly enough when you have an episode of low blood pressure.

Best wishes!

Is it possible

by BillH - 2015-12-09 11:12:04

That they only reduced the voltage on the ventricle pacing so that while the lead is still "active" and works with CLS the leadd will not "fire" the ventricle?

Things like this is reason that a person needs to ask specific questions and get a copy of their settings.

Bill H.:

by Marday - 2015-12-10 02:12:49

They tried the V lead at three different micro voltages. All produced the same result subjectively. It's a wonder to me that these things stay put at all given the heart's continuous convulsion.

As for snitch, I imagine the goal is to have both leads working but just for now they would like me to be off the beta blocker and pain free for a few days. Jury is still out on repositioning the lead. I imagine they will x-ray come Monday.

Second interrogation

by Marday - 2015-12-15 03:12:37

So now it's like: "well, If you want, we'll just go back in and fix the minor problem that isn't a problem, you just say."

This applies to the (misplaced, moved?) ventricular lead on the Biotronix dual lead system.

So, after surgery the only person I've seen (two weeks out) is the nurse, practitioner. She's putatively in touch with the Dr.

Anyway, I kind of experienced this visit as a colorful candy shell encasing whatever truth I'm supposed to be grasping. Do these people go to law school?

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