Return of PMT?

Is a PMT fix permanent?

by Gotrhythm - 2023-06-09 14:21:06

Your questions are good ones. Having dealt with the same PMT issues, I can tell you the answer is, yes and no. 

A long time ago, 8 or 10 years, I was discovered to have an unusual (i.e. difficult to diagnose) PMT. My EP was able to correct it with equally unusual settings, and I had no more problems until it was close to time for a replacement. I developed what was diagnosed as paroxysmal supra ventricular tachycardia, PVST for short.

After the pacemaker was replaced, I began having symptoms and enquired several times if I could be having PMT. I was repeatedly assured the PMT was "impossible" given my settings which were the same as before. And yes, my symptoms included steadily increasing and uncomfortable PVCs.

Then another club member posted about a little known problem, RNRVAS, which is a sort of PMT that can't be tested for, but can be observed as it is happening--if the tech is looking for it. At my next pacemaker check, I enquired about it. The tech was able to observe it. My settings were changed and everything has been fine since. I have had no PMT-like symptoms and also no PVST! I very much suspect now that the problem actually started even before I got the replacement.

I'm not suggesting that what you're experiencing is the same thing. Clearly I have no way of knowing. But I've told my story to show you that is is possible to have PMT, have settings that permanently prevent it, and then have something different--but similar--happen again later.

BTW--I'm 80 too.

Thanks Gotrhythm

by benedeni - 2023-06-09 15:02:35

Hello Fellow Octogenarian!  Thank you for always responding in a manner in which I can understand!

I shall take pen and pad with me to the doctor and then be able to remember what is said!  Interesting how similar these problems of PMT, PVST and RNRVAS are.  Your story provides much food for thought.  

Thanks again.

Kardia Mobile

by Penguin - 2023-06-09 15:08:37

I believe that the Kardia mobile provides a heart rate for the A.Fib?  

1. Compare this to a setting named the ATDR (AT Detection Rate).  This is the h/rate above which your device has been programmed to detect atrial arrhythmia. E.g. if the ATDR is 160 bpm, the device will only detect a.arrhythmia above 160 bpm. 

If your A.Fib occurs at or below your programmed ATDR the device will not mode switch to a non tracking mode when A.Fib occurs. This can cause a PMT event. 

2. Check your settings for the PMT detection rate. This is also programmed in bpm.  This setting automatically terminates PMT but again it will only terminate PMT that falls above the detection rate.   

When you have PMT symptoms use your Kardia mobile and find out the heart rate at which it occurs. Compare this to the PMT detection rate. 

3. Ask your techs about Rate Response. If your h/rate is rising and falling unpredictably and RR is 'on' you can have it programmed so that your h/rate falls back down again very slowly. This avoids any sudden drops in h/rate which might trigger a.arrhythmia and PMT. 

Short answer - yes PMT can recur depending on how your techs programmed it 'away'. The programming might only cover you for certain h/rates and circumstances.  There may be other triggers/circumstances which have evolved since. 

I'm not an expert on PVCs but know that they can trigger PMT.  Perhaps somebody else can shed some light on programming that might help with this? 

Best Wishes

And Thank You Penguin

by benedeni - 2023-06-09 15:15:53

I will try and follow your suggestions re the Kardia.  I do know I asked at the time of reprogramming if the RR was turned off and the answer was no, it's still on but not being used.  More food for thought.  Thank you.  It's so good to know I am not alone.  

Return of PMT - not necessarily

by Gemita - 2023-06-09 15:49:53

Oh Benedeni, you made me laugh.  At 80 nothing will ever change?  I love your optimism and you are going to go far with that attitude.  Sadly our electrical disturbances whether they be pacemaker generated, heart, illness related (electrolytes, infection, thyroid, inflammatory auto immune condition and so on) will never stay the same, so we have to be a step ahead of them all the time and be prepared to make changes to both our lifestyle and our pacemaker settings.  Medication changes or dose increases/decreases can also affect our pacing requirements, requiring pacing adjustments, so that is another factor.

It sounds to me from your symptoms that this could be caused by an arrhythmia too rather than PMT and perhaps you will need further long term external holter monitoring to see the actual rhythm disturbance present.  I wouldn’t assume it is the same problem.  They will need to identify the rhythm disturbance present for you to have the best possible chance of getting it corrected (as Gotrhythm’s experience has shown all of us).

So, no is the answer to your question - nothing in life is permanent and that includes our electrical disturbances.  Our disturbances change and our pacemaker settings have to keep up.   I have read that the most common reason for reprogramming a pacemaker at the time of follow up is for an arrhythmia and the most frequent programming change is the stimulation mode (Rate Response).  I am wondering therefore whether RR is part of your problem Benedeni?  Do you absolutely need it on, or could you manage a trial period without it to see whether your ectopics and therefore Afib might ease?   

I had a 3-month trial of Rate Response last summer and I noticed an increase in ectopics and tachycardia, well actually an increase in all my arrhythmias.  It has been temporarily switched off and I am doing so much better.  I have also had another setting switched off because it was competing with another setting which helps overdrive pace my slower, pausing atrial ectopics which are frequent triggers for my Afib.

You are going to become an expert on settings with all these adjustments and I hope you will return and let us know what changes have been made, what arrhythmia has been seen, so that we may all learn and benefit.  I hope your symptoms improve quickly so that you can enjoy life to the full again

Gemita, as always I appreciate you!

by benedeni - 2023-06-09 16:17:32

I hope I do become more knowedgable about these issues, Gemita!  Your suggestions are sincerely noted!  With your suggestions and those of Penguin and Gotrhythm I'm feeling ever so much better.  Of course nothing stays the same and now I know that is particularly true of our heart conditions.  Silly me thought, well, they said it was fixed so it can't be the pacemaker.  And as you said, it may not be related to PMT at all.  I know one thing for sure and that is this next visit I am going in more prepared and will make sure my hubby has his hearing aids turned up as far as they will go!  

As for the RR.  I asked at the time if it would be turned off for this new setting and was told no, it would be on but it wouldn't be doing anything...didn't seem to be doing much anyway.

So!  I am better prepared for my appointment and sincerely thank you, Gemita.  

((Hugs))

by Lavender - 2023-06-11 07:42:16

Lol at your hubby having his hearing aids turned up so you have an extra set of ears listening to the advice given!  
 

My rate response is turned off. They said I don't need it. 
 

May new solutions come to light to help you feel better, my dear!

Agree, Lavender

by benedeni - 2023-06-11 10:14:37

Thanks Lavender.  I agree about the rate response.  Depending on what shows up with this visit, I will certainly see if that rr is the right thing for me or not.  I know when they first turned it on I sure didn't feel any better.  Then they found the PMT thing going on and now that setting is obviously not working anymore,  soooo... back to square one!  T'will be a welcomed visit in any event..