time for replacement PM

Metronic

by Good Dog - 2023-07-04 11:06:24

Natalie,

I don't know which model Medtronic PM you have, but when you reach elective replacement most of them switch modes to pace at 65 bpm and pace only the ventricle. They do that to preserve battery life. What you are feeling now is exactly what happened to me when I reached ERI. Some folks have few if any symptoms when that happens and some get SOB and feel terrible. I am in the latter category. So I have convinced my Doc to switch mine out as soon, but before it reached RRT/ERI.

Now I am not saying that is what is happening to you, because I have no way of knowing. Take your pulse (in your neck) and if it is a constant 65 bpm, then it is pretty likely you have reached ERI. It is important to know that there is no danger even if you feel crumby. When you hit ERI you still have about six months of battery life remaining. So not to worry if you are there.

Given that your battery lasted as long as it did, it seems that your heart is in very good condition. If you do not feel well, then do not hesitate to bug your doctor to get you in ASAP so you can feel good again. I know that you tried......just don't give-up!

I hope this was helpful, but in any case, you have nothing to worry about!

Sincerely,

Dave

Battery

by AgentX86 - 2023-07-04 11:24:37

It does sound like you're at ERI, though they say otherwise.  It may be something else but it's worth a lengthy bitch session "If it's not EOS, fix it!". If it's something else, replacing the generator won't fix it, so fix it now. The problem, as i see it, is that many insurance companies won't pay for a new one until it's at its end of its service life, whether that's at "EOL" or for some, "EOS" (i.e. not "elective").

Eleven years is really good. It's obviously old so wouldn't have Bluetooth.  Does it have any way to call home? If so, that would be one way to test it more regularly. When mine gets to ERI, it will be considered an emergency so it's set to call home the instant the EOL flag appears.  I'm PM dependent and my PM has been recalled for a potentially capacitor problem that could drain the battery very quickly. It's tied to my phone so it can send the SOS immediately. I am paced VP only but it will shut down RR, the CRT function, and drop the rate from its normal setting of 80bpm to 60bpm. It should tell me, in no uncertain terms, that there is something wrong.

thank you to Good Dog & AgentX86

by natalie - 2023-07-04 11:31:04

Thank you for easing my mind.  I will keep after my doctor and it's good to know I've got more time and to watch out for my insurance.  It continues to boggle my mine that some person in a cubicle can determine my medical needs. 

Insurance

by AgentX86 - 2023-07-04 11:49:19

It's double dumb beacause they're going to pay this month or next.  Is there really a difference?

THe dirty secret is that most private insurance claims are really passed through to the employer at some point. IOW, the insurance company isn't paying anything.  The employer is,  if the company is larger than about 100 employees, it is self-insured with the insurance company just manageing the claims. I guess the difference is that you may not be working at the same company in three months (hint, hint).

pacing ranges from 60 to 80

by natalie - 2023-07-04 11:50:45

Another question, the atrium paces 77% of the time and the ventricle only paces 1% of the time.  

Since the atrium is going to stop pacing and the ventricle paces at 65, could that be why my pacing ranges from 60-80 because it typically only paces 1% of the tim.  

When pacing drops to 60, it feels like I'm in a plane or elevator decending rapidly.  I don't like it. 

You got it.

by Good Dog - 2023-07-04 12:09:54

I know the feeling! Yes, I think that is exactly why! Have you taken your pulse? Is it 65 bpm? If it is that answers the question. 

Agent86 is correct. It is stupid for the insurance company to make you wait until ERI for replacement. Actually, I have found that the Doctor does in-fact have the ability to get it approved ahead of ERI. Out of three generator changes for me I only went to ERI one time. I swore; never again! I think the Doc just needs to give them a simple justification. Not exactly sure what they have to tell the insurance? Perhps it is as simple as just; you feel like "shit".

Sincerely,

Dave

Hugs

by Lavender - 2023-07-04 20:01:50

I'm sorry to hear of your distress. It should not be necessary to wait til the point of anxiety before you get a replacement.  You've gotten your insurance company's money's worth out of it! 

ventricle pacing rate

by natalie - 2023-07-06 10:44:25

Good Dog, I have been checking my pulse and it is not consistent at 65.  It fluctuates between 60 and 100 throughout the day. depending on what I'm doing.   Just now I felt it drop and it was 61 and I'm just sitting and typing. 

My ventricle has only been pacing 1% of the time for the last several years.   

So, with that, does it mean that the ventricle will pace consistently now or will it remain at my standard 1% of the time?

ERI?

by AgentX86 - 2023-07-06 21:20:44

Your SI note can still control the heart, it just has to beat facter than the settings of your PM. Likewise.  Your heart could be driving the rate up and the pacemaker would just stand by and watch. Activity driving the rate up to 100 would be perfectly normal. The PM isn't doing anything.

Likewise, if your AV node is working properly, the the lead in the ventricle does nothing.  It just sits and watches. This is why you're getting the low percentages. Your PM is just waiting for something to do.

The constant pacing modes will only be relevant if the SI or AV nodes screw up.  If the heart is functioning normally, you wouldn't need the pacemaker and it would do nothing anyway.  As it is, it's just there waiting to catch you if you fall.

End of life (battery)

by piglet22 - 2023-07-07 07:13:57

One of the characteristics of lithium battery (cell) chemistry is that there can be a sharp fall in voltage when it starts to become depleted. It's not a gradual falloff like other chemistries.

The pacemaker will certainly be monitoring that.

My first pacemaker did 11-years and was monitored at the clinic every 3-months. Even that did not prevent failure.

Symptoms of failure were twitching pectoral and forearm muscles which was put down to mode change. While awaiting replacement after admission, the technician was able to raise the threshold enough to stop the twitching.

What should have been a normal arranged admission turned into an emergency.

I think the physiologists should have changed the PM earlier instead of trying to wring the last drop of power out of the device.

I'm going to be a lot more wary the next time.

not pacing in ventricle and insurance grrrrrr

by natalie - 2023-07-07 09:08:08

I met with my doctor and I have now learned that the mode has not switched. I am not pacing in the ventricle and have not sustained arrhythmias. My Insurance does require ERI triggered for battery change out.

You know when you have your cell phone on vibrate and leave it in your lap, how that feels throughout your body, well that's what I felt a lot in May and early June in my chest.

Then during my June annual visit, they scared me when they told me I had 1/2 month to 12 months and that I would definitely not make 12 months on this battery.  They described what I need to watch out for and perhaps I'm paying too much attention to myself?

In the mornings, I feel pretty good and make the most of that energy.  But soon after the activity, I'm wiped out for the rest of the day.  These activities range from yoga, to house cleaning to gardening. None of those are worthy of being wiped out for the day.

So, I will see my doctor again in August.  I'll keep in touch with yall and take care of myself the best I can for now. When my body wants rest, I'll do it. Right now, I'm going to yoga.

Hang in there.

by PacedNRunning - 2023-07-09 03:10:12

Natalie. I just went through this! it is stressful waiting and watching it tick down. My doctor was able to get mine approved. Im Not sure how but I think they can justify it if needed. . I had less Than 3 mos to ERI at replacement. Hopefully not much longer. Once it goes to ERI, it just won't let your HR fall below 65. It will only pace to keep you above 65. So if your own heart can keep you at 66, it won't pace. But it will only pace in the lower chamber. Hopefully you get a replacement soon. Hang in there.