3 Month Upload Report - Questions Abound!

I see my Cardiologist next Tuesday but with the bevvy of street savvy folks on this site, why wait!  

So I've got all 50 page of the report that were dropped into my EMR.  Bottom line seems to be that the pacemaker is functioning just fine and has about 11.5 years of life.  All nice!  However, I'm trying to decode of the summaries and want to know if I'm on the right track.

Background: Metronic Azure placed for CAP secondary to a LBBB.  No other cardiac issues or arrhythmias.  My current tracking is 60 / 130.  PM placement was May 1.   The events noted seem to have occured in the last 28 days which happens to  coincides with when I returned to an active exercise program.  The report shows as follows: (this is a cut / paste of summary)

Normal Remote: With Events
Normal Device Function
Events or Alerts: 26
Battery: OK, 11.50 yrs
Sensing, impedance and thresholds reviewed
Programmed parameters reviewed
RA and RV pace/sense bipolar
Presenting rhythm reviewed
Hx SR
Heart Rate Histograms reviewed
Non-sustained Ventricular Tachycardia
Stored EGMs are consistent with or suggestive of Non-sustained VT
Total episodes: 1
Sinus Tachycardia
Stored EGMs are consistent with or suggestive of Sinus Tachycardia
Heart rate: 158bpm

I'm guessing that these event alerts are pobably related to my exercise when my HR regularly goes into the 150/160 bpm range, so I'm not too fussed. (The number of events vs the number of days I was training ane my Polar recorded HR.)   Also assuming that the number of these events can be reduced by requesting that my upper tracking be raised to 160 or 165 and my lower tracking reduced to 45.   

Am I on the right track???

7 Comments

this is your first report

by new to pace.... - 2024-07-18 20:07:47

From my knowledge of these reports.  Looks good to me, i would wait until your next report before you ask them to raise or lower your rates.

I generally just ask for the log events and then get the summary page.

new to pace

Are you on the right track?

by Gemita - 2024-07-19 18:18:03

Are you on the right track?  Well you have done a cut and paste job, so I am not sure what you have left out.  I would want more info on the 26 number of events/alerts.  What exactly were the events?  Were they for example high atrial or high ventricular rate episodes or both?  I see one stored EGM is consistent with or suggestive of one episode of NSVT.  You perhaps need to ask about the duration and how high the ventricular rate went although a one off is probably not significant.

Sinus Tachycardia, stored EGMs are consistent with or suggestive of Sinus Tachycardia, one episode at a heart rate of 158 bpm.   How many episodes of Sinus Tachycardia did you have?  If only one, what were the other 24 alerts/events? 

Since there were 26 alerts, you cannot assume this is related to exercise.  The pacemaker would not give an alert for exercise induced high rates, since it can tell the difference I was told between exercise and arrhythmia induced atrial or ventricular high rate episodes, so you need to ask questions about these alerts and what they mean for you?  I also don’t see how these events can be reduced simply by requesting that your upper tracking and lower rate limit be adjusted.  So no you are not on the right track, in my opinion.   

I am not suggesting you are in trouble and hopefully your cardiologist will not be overly concerned about 26 alerts over a short period but they need to be explained properly and if these are high atrial rate or high ventricular rate episodes they may need to be watched and treated while you are settling down to being paced.

Additional Info that might help

by Andiek11 - 2024-07-19 21:50:05

New to Pace and Gemita, thanks for your responses.  I'll call this my "second" upload if I can count the first upload as the one done about 10 days after implantation.

I'm not quite sure what "info" from my upload is helpful to understanding / interpreting my data, but I'll add a bit more below and explain why it appears to be strongly connected to my workwouts.  Below are the details of the "events" noted in the summary ( more cut & paste but no data editing - only formating adjustments on headers to make it more readable):

Type / Event # / Date /   Time / Durat / Avg BPM/ Max BPM / A/V activity at Onset

SVT-ST 29 13-Jul-2024 08:20 :01:32  158/158     162/162     Active

SVT-ST 28 13-Jul-2024 08:17 :29       154/154      154/154     Active

SVT-ST 27 13-Jul-2024 08:09 :01:47  158/154      273/158      Active

SVT-ST 26 12-Jul-2024 07:14 :10       158/158      ---/---           Active

SVT-ST 25 10-Jul-2024 06:48 :29       154/158       162/162       Active

SVT-AF 24 10-Jul-2024 06:47 :26        176/158       ---/---          Active

SVT-ST 23 10-Jul-2024 06:45 :16        207/154        ---/158         Active

SVT-ST 22 10-Jul-2024 06:42 :01:19   154/154      171/171        Active

SVT-ST 21 10-Jul-2024 06:40 :28        158/158       158/158       Active

SVT-ST 20 10-Jul-2024 06:39 :09        154/158        154/---          Active

SVT-ST 19 08-Jul-2024 07:16 :06          162/162        ---/---           Active

SVT-ST 18 08-Jul-2024 07:11 :07          154/154      154/154          Active

SVT-ST 17 08-Jul-2024 06:58 :06          158/158      158/158          Active

SVT-ST 16 04-Jul-2024 08:32 :01:07     158/158      162/162        Active

SVT-ST 15 04-Jul-2024 08:29 :45          154/154       158/158         Active

SVT-ST 14 03-Jul-2024 06:33 :37           154/154      158/158         Active

SVT-ST 13 03-Jul-2024 06:31 :31          154/154       154/154       Active

SVT-ST 12 03-Jul-2024 06:29 :33          207/154        ---/158          Active

SVT-ST 11 25-Jun-2024 06:42 :54         154/154       154/154        Rest

SVT-ST 10 25-Jun-2024 06:36 :42         154/154        154/154        Active

SVT-ST 9 21-Jun-2024 08:34 :11           154/154         154/154        Rest

SVT-ST 8 19-Jun-2024 06:20 :48          158/158          158/158         Rest

SVT-ST 7 19-Jun-2024 06:11 :47          158/158          158/158          Rest

SVT-ST 6 14-Jun-2024 07:10 :01:55    154/154           162/162        Rest

SVT-ST 5 14-Jun-2024 07:08 :01:37    154/154           158/158         Rest

Each one of the above dates and times correspond to workouts which are tracked on my Polar Flow app.  What's impressive, is that the BPMs noted above are wtihin one or two beats of what my Polar optical sensor watch recorded in all but one or two instances!  (Hmmm, perhaps my fitness watch is more accurate than I gave it credit??).  I can see on my fitness app the days when my heart rate has not risen above 130 bpm for any reason, that no events are recorded.  The above date/time correlations are what to me strongly suggests the exercise connection.  I could be wrong and I'll update all after my appt next Tuesday.  Borrowing a concept from Mindfulness, "Beginner's Mind",  till my appt I'll just leave my mental door "open" to discovering what this really means based upon my cardiologist's interpretation and not jump to any conclusions (good or bad) in advance.   

 

I would keep an eye open for Atrial Fibrillation (AF)

by Gemita - 2024-07-20 00:26:55

Andie, thank you for the additional information.   It gives far more detail and it also tells me that you are getting tachycardia sometimes at rest too.  For me an event is an event and wouldn't be stored if it had absolutely no significance.  In other words, an event has to reach certain parameters set by your EP to be recorded and stored, so these will be true events with their own particular ID like SVT/ST, SVT/AF.  Of course following up with an external ECG would absolutely confirm the arrhythmia present when there is doubt, which is why further monitoring might be helpful to confirm the presence of AF.

 Looking down the list you provided, they are short lasting episodes, often stopping and starting several times during the period of the listed rhythm disturbance.  I also have a Medtronic and I recognise the data you have submitted which seems to be from the Arrhythmia Episode List.  

In your shoes I would probably want confirmation of the arrhythmias you are getting and their implications when you go to see your cardiologist.   Confirmation perhaps by way of some additional external holter monitoring to look for Atrial Fibrillation which may need treating.

I note in particular one episode of Atrial Fibrillation was recorded as SVT/AF, whereas all the other arrhythmias were SVT/Sinus Tachycardia (and of course the one episode of non sustained VT given earlier).   The SVT/AF (Event 24) was recorded on 10th July at 06.47, ?lasting 26 seconds.  

I am not suggesting that you jump to any conclusions, but if AF is occurring and confirmed by either additional holter monitoring or pacemaker downloads, this may need watching because it only takes a short run of AF to put us at a stroke risk if we have risk factors, although I am not sure that you have risk factors that requires anti coagulation?  Risk calculator link below might be helpful if you are female and over 65.

I agree with you, let us wait for your cardiologist to give his opinion on your overall results.  I have given you my observations from your data excerpts as you requested and I hope they are helpful without causing undue concern.  I recall it took me 3 months+ for my heart to settle after implant.

https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk

Rest vs Active

by Andiek11 - 2024-07-20 11:53:30

Gemita - 

I've wondered about the events recorded at "rest" too because the days / times it says the events were at "rest" were times that I was in the gym, actively working out, and the heart rates shown on the upload match what my polar app recorded.  So I guess I need to understand what the definitions of "rest" and  "active" are from the PM's perspecrtive.  Oh well, one more question for the long list I already have for the doc next week.  ;)

quesitons

by new to pace.... - 2024-07-20 14:50:35

do not bring long list of questions as you will only have just so long.  If there is a way you can email some of your questions ahead of time might help. Or just ask the main ones and save the others for another time.

By the way if the doc was concerned their office would have contacted you about those.

new to pace 

Thanks!

by Andiek11 - 2024-07-20 15:06:41

New to Pace - exellent reminder and I totally agree that if there had been any "urgent" findings that I'm sure I would have received a call and not just a series of autogenerated notices that the upload was sucessful and the PM was functioning properly. (lol, love the human factor but I can deal with this as long as all is okay).  I plan to send the list of questions to his RN this weekend, so my doc will  have had an opportunity to review (or to call in sick that day.... *lol*) before my appt on Tuesday.  :)   

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