The story continues

Well.

As you might remember RNRVAS had reared its ughly head so I returned to the clinic. Forewarned, the PA and tech had conferred with St.Jude about how to deal with the problem, so this time they didn't tweak the AV delay, they wiped the previous settings and took a differenent approach.

It worked and I have had no more PMT episodes.Yay. One good effect is being comfortable driving again. I have even been able to give rides to a friend who was temporarily restricted from driving after having had an ablation. Trust me, I owed her plenty.

It's particularly heartening to make plans with the reasonable assurance that when the time comes, I'll be able to carry through. Yesterday, I made a good beginning on cleaning out a closet.

Unfortunately, PVCs which had diminished to no more than three or four a week on the old settings, are back, and coming in multitples. Grrrrrr! 

In the past, multiple PVCs were a harbinger of PMT. Maybe they won't be this time. I'm hoping. But I'm also glad I insisted on making an appointment for a re-check in May.

 

4 Comments

Good report!

by Lavender - 2024-04-11 13:24:36

Sorry the PVCs are showing up but overall it sounds very good to know you're back with less restrictions on your activities. So nice you're able to repay your friend with rides!

I hear you on the plan making-I always say "God willing I will be there. "😉

They could do better

by Gemita - 2024-04-11 16:05:53

Gotrhythm, you sound in control again, apart from those ectopics.  Clearly your settings changes haven’t been optimised if you are trading one rhythm disturbance (RNRVAS) for another (PVCs).  I too am glad you are going back for a re-check in May.  We can work out what to do next and get you well prepared. 

Are you still pacing in AAI mode, do you have Rate Response turned on?  Deactivating RR if you don’t need it, may help.  What is your Base Rate?  A higher Base Rate can help overdrive pace PVCs and reduce their burden and can be a quick fix for some of us.  I have bradycardia induced PVCs and PACs.  There is no doubt that pacing at 70 bpm has helped me reduce my overall ectopic burden, a burden which clearly caused severe symptoms and often led to more serious arrhythmias, including atrial fibrillation from the PACs and non sustained VT from the PVCs.   I remember how poorly I used to feel with them before my pacemaker.  I frequently felt I was on my way out.  

Let us use our pacemakers to our advantage, but we have to work on those settings first and to fix any “backwards” conduction and timing issues between the upper and lower chambers.  

Go back over the FAQs on RNRVAS and also on Pseudo-RNRVAS to see if you can find any tips and also go back over Pacemaker Mediated Tachycardia, so that you can challenge your team when you see them in May.  There has to be an answer for all of this and we will find it.

Positive Progress

by SeenBetterDays - 2024-04-12 07:38:20

Hi Gotrhythm, I'm so pleased that you have been able to get some relief from the PMT episodes and that this has given you the added freedom of being able to drive again.  I hope that the PVCs diminish this time and you are able to banish those pesky ectopics.

It's good that you have a further check in May so you have an opportunity to discuss any ongoing concerns you may have or, as Gemita said, any potential setting revisions.

Just lovely to hear that you are feeling positive and able to enjoy more independence again.

Keep us posted.

Love and best wishes, Rebecca x

Helpful - Unsure?

by Penguin - 2024-04-14 14:08:10

This may back up what Gemita is saying about using a higher base rate: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640207/

The second article below (much shorter) is relevant to your own pacemaker from Abbott, which has an atrial pace setting that you may or may not have switched on. 

https://www.heartrhythmjournal.com/article/S1547-5271(23)03023-0/fulltext

 

 

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