Can pacemaker see everything?

Depends what has been set up

by Gemita - 2020-10-17 03:27:37

Unfortunately a pacemaker will only record what it has been set up to record, so unimportant stuff may get rejected.

As an example, my pacemaker has been set up to record a significant rhythm disturbance when it exceeds a certain heart rate (say above 160 bpm) or continues for a certain duration.  If a rhythm disturbance doesn't meet the parameters set by the technician for the recording of an arrhythmia, then a rhythm disturbance say at a slower speed/shorter duration may be rejected.

As you will appreciate, not every single irregular heartbeat or rhythm disturbance will, or can be monitored.   But it will log, for example, a fast or dangerous arrhythmia, show histograms of highest/lowest heart rates, arrhythmia burden, duration of any significant events like Ventricular Tachycardia, Atrial tachy arrhythmias providing these meet the conditions set up.  An alert should be triggered for anything significant or an ECG recording of a significant event should be available to download.  (One was at my last Medtronic check which gave them additional information of the disturbance - Non Sustained Ventricular Tachycardia/Atrial Flutter were seen).   Do you have home monitoring?  If so, you could ask whether you could send a transmission in for analysis when the disturbance actually occurs.

It sounds as though you are getting ectopic beats (not usually serious and are extremely common) or you may have other rhythm disturbances.  I would speak to your clinic and get some additional monitoring (?Zio patch or holter monitor) for a couple of weeks which should give more information than your pacemaker is programmed to provide.  

Your pacemaker shouldn't let your heart rate fall below the set minimum.  With ectopics I know it can feel like your pacemaker isn't quite keeping up.  I feel this too.  Ectopics feel like skipped, missed, pausing, exceptionally slow heart beats that can be difficult to tolerate I well know when they are prolonged and frequent.  Your doctors may want to do a few pacemaker checks or maybe review your medication if you are symptomatic.  Good luck

It depends

by AgentX86 - 2020-10-17 13:04:05

As Gemita says, PMs can only record what they've been told to record.  Within that, there are a lot of things they cannot even be told to record.  For instance, my Medtronic Percepta Quad CRT-P can't record PVC unless there is a string of at least five in a row.  The threshold can be set above five but not below.  It completely missed my bigeminy because the PVC run length is one, so falls below the threshold even though it happens after every heartbeat there is a PVC. 

Since it's incapable of recording this condition it can't trigger any other event recording either.  I had to wait until it was happening, then do a remote transmission.  Then the problem was obvious and the tech on the other end even knew what it was, before my EP even saw the strip.  Not a big deal, as it turns out but damned uncomfortable.

Your pacemaker (for AV block) just acts like a wire (repacing your AV node) from your atrium to your ventricle.  When the PM senses a pulse on the atrium side, it waits some period then fires a impulse into the ventricle.  There is also an option where the pacemaker will, after some programmed time, supply a pulse to both if it doesn't detect the atrial pulse.