Looking for EP cardiologist that specializes in PM settings for younger/active patients

HI, 

I was wondering if anyone could recommend an EP in Atlanta, GA that they know of who sees regularly, younger/active/athletic patients. I have a medtroinic Azure XT device placed a year ago for intermittent 2nd to 3rd degree AV block that occurs with exercise. I have been struggling to get the settings of the pacemaker right and I have seen 2 different EP's but they both comment that they mainly seeing older patients so usually it isn't so hard to get the settings right. They are trying to get a balance where I am being paced when needed with exercise but not all of the time and it seems I keep going from one extreme to the other. Any recommendations would be appreciated!

Thank you!!

3 Comments

Sports Electrophysiologist in Atlanta

by AgentX86 - 2021-11-04 16:34:10

I live in the Atlanta area and have an excellect EP, though I don't think he's exactly what you're looking for.  However, Emory University Hospital does have a sports cardiology department.  You might start there.

<https://www.emoryhealthcare.org/centers-programs/sports-cardiology/index.html>

I have the same as you.

by PacedNRunning - 2021-11-17 01:46:04

I got my PM for exercise induced high grade block. 2nd to 3rd.  So we are similar. We programmed the PM to only pace once my HR went above 110bpm which is when I would go into block. Usually my block would start 130+.  Then when my HR slowed down after exercise my own heart would take over.  They should make your AV delays so that the exercise delays matches a physiologic PR interval somewhere between 70-90ms. The resting delay should match a physiologic PR interval.  Since you have Medtronic they should be able to program a normal AV delay at certain HR ranges.  I had very loose settings so the beginning of running I would be really out of breath for about 2 mins until the PM caught up with my HR. After that I was good to go.  It's a give a take and won't be exactly as if we didn't have a PM but it does take time to adjust when you pace in the bottom chamber during exercise. They made a lot of adjustments for me to get it feeling tolerable. Then just small tweaks here and there to get it as good as it can be.  About 18 mos after my implant I developed block at lower rates.  Now I'm persistent block 24/7. super bummed but it is what it is.  I did a bunch of googling of exercise and PM's. I worked with my EP and Boston tech to help optimize my PM.  We tried alot of things.  Most aren't good with active people but try and find an EP that works with younger paitents. Feel free to PM me if you have any questions since we are similar. 

Sports Pacer

by Mike417 - 2022-01-01 11:12:55

You did not mention what sports/activities you are doing.  The Azure has only one accelerometer, which may not support active people.  Call or contact Medtronic customer support, and ask if your PM can support the type of activities you do.  I was told, after a year, that no program would allow the PM to support physical activity.  My solution was to change to the Boston PM with multiple accelerometers and MV sensor.  You will have to argue strongly to get them to do it, and you may want to bring an advocate with you.

PM me if you want to talk further about it.

Mike

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In fact after the final "tweaks" of my pacemaker programming at the one year check up it is working so well that I forget I have it.