Outsourced PM Check "Visit" Report Finally Came In The Mail

by IrishToast
2024-07-29 20:28:59
Checkups & Settings
292 views
9 comments

As I previously posted, I was scheduled for a Rhythm Management Group remote "visit" (no visit) on June 13. The 7/2/24 chart report had no information. PM Clinic said that it means all is good. I requested the full report. It finally came in the mail today, sent from my local PM clinic. I am happy all is well. But it leaves me with many unanswered questions. Besides name, rank and serial number, this is all that is on the single page:

TINY LINE GRAPHS for >0 month to what looks like 2.75 months:
Battery Voltage (V): Looks like 3.05 line drawn to a little less than 3.0
RA Capture Duration (ms) at 1.0 V: Straight line at .4
RA Sensing Amplitude (mV): Straight line from 2.5 up to 5
RA Pacing Impedence (Ω): Straight line from what looks like 430 down to 400 maybe
RV Capture Amplitude (v) at 0.4 ms: Looks like .75 straight line up to 1.0
RV Sensing Amplitude (mV): Straight line from 7 to 12
RV Pacing Impedance (Ω): Looks like maybe 520 straight line down to maybe 480

ENCOUNTER SUMMARY:
Presenting EGM: AS/VP
AP 3.9% VP 97% Estimated battery longevity 9.5 years.
Events: No new device identified events

That is all it has. There are numerous fields that could have been filled in about mode, hysterisis settings, other rates, sensitivity, sleep rate, AV delay, swittch modes, other delays, etc. But nothing is filled in. Earlier this morning before the mail came I called Rhythm Management myself. It was answered by an "oversees" call center, who transferred me to "billing", where I spoke to someone with an Asian accent who could not answer my question whether anyone reviews data from the Merlin at Home in between these 3-month downloads. I don't see the EP until February, and my PM Clinic is in March. So, in between these, it's ER if I ever feel bad? I will try to get that answered.

Now to the report itself. My husband and I are wondering if the Ventricular Pacing of 97% is higher than it should be, because my heart rate wasn't dropping that much before the pacemaker. Is it possible to set a PM to kick in sooner than would be necessarily? I have read recent discussions here about more ventricular pacing could possibly lead to problems later. I would like to stay as healthy as I can, obviously. Any comments are appreciated.

9 Comments

if they did not call all is ok

by new to pace.... - 2024-07-29 20:32:42

Someone some place looks at these report. when certain numbers do not jump out at them. You will not recieve a call. Be thankful for that.

new to pace

Hi

by Lavender - 2024-07-29 22:17:52

How frustrating not to be able to be seen in person and ask your questions. I think you have to focus on the part where you're told everything is fine and no one needs to see you til next year. Of course go to the ER if you have problems.

I do not think they ever set a pacemaker to kick in before it's needed. I am 100% paced in the ventricles. Hey if you need it, you need it.

Ventricular Pacing.

by Selwyn - 2024-07-30 05:14:32

Heart block (such as yours) with a rate of 44 bpm is a reason for ventricular pacing. Without this you have the problem of collapse and also possible cardiac arrest.

There is a small risk with ventricular pacing of pacing induced cardiomyopathy due to dysynchrony between the atria and ventricles . The risks are minimal with atrial sensing if that is possible ( hence two lead PMs are much to be preferred). You should be OK with heart block and with two leads so there is some co-ordination between the atria and the ventricles ( thanks to your pacemaker sensing in both chambers)

I used to have two lead sensing and pacing ( DDDR) - now in atrial flutter this is not possible. I discussed the risk of heart failure at my last out-patient visit as I am now 100% ventricular paced. I will be monitored with regular echocardiogram ejection fraction scans. It is hoped to pick any deterioration early so that there can be further management to prevent a worsening.

Outsourcing

by piglet22 - 2024-07-30 05:22:58

This is becoming the norm and I've no problem with it providing it covers all the bases and isn't simply dumped on you without explanation and could be seen as cost-cutting.

This was the UK way in my health trust.

Personally, I like some feedback even if it's a 10 minute phone call once a year to say that all is well.

Too many services are going down the same route. Not everyone is comfortable with purely digital interactions.

Dysynchrony?

by IrishToast - 2024-07-30 09:57:51

Thank you all. I am certainly comforted that all is well. But I also want to learn more about my situation and PM settings for future health monitoring and decision-making. Selwyn, you mention dysynchrony. Is that the reason the PM sends a signal as soon as it does, even when my heart rate is not low? We are wondering if it were set to wait longer it wouldn't be needed as frequently. But would that cause dysynchrony then? Is there a term for a setting that determines such a delay?

Delays

by sgmfish - 2024-07-30 21:26:24

My docs and I have been attempting to program my PM to enable less paced and more sensed triggers to my right ventricle. It has worked to some degree. On my PM, the settings we are using are called: "Paced AV delay" and "Sensed AV Delay". Some other settings are involved too; namely, "Ventricular intrinsic preference (VIP)", "VIP extension", and "PVARP".

EP nurse is supposed to call me back

by IrishToast - 2024-07-30 23:47:14

I called my PM clinic. They will only see data from my Merlin bedside when it is sent to them by Rhythm Management, which only looks at it on the three-month "visit", unless the monitor sends them some kind of event notification, which will then be sent by them to the PM clinic. I will ask the pace percent questions when the EP's nurse gets back to me. Thanks for the helpful info that I can ask about.

97% Vp

by Rch - 2024-07-31 02:48:20

From your Bio, you have Mobitz Type 2 heart block with baseline HR of 44. 97% Vp is a bit too high for a 2nd degree heart block with an underlying HR of 44. I'm wondering whether you have progressed to complete heart block. So, I would suggest you insist on seeing your device tech sooner than March 2025!!!

Spoke with the Pacemaker Clinic Nurse

by IrishToast - 2024-08-01 15:20:14

My EP's nurse called yesterday and answered a lot of those questions. I am still learning, so there is much that she said that I didn't quite get, but here is how I understand the gyst of it. They want VP pacing to be at least 90%. Yes, pacemaker syndrome can occur, but the same risk exists more so for too little pacing. I have a newer Abbott lead product that is attached to the RV wall in a carefully selected location nearer the LV so that it basically acts like a CRT, maintaining synchrony. I hope I am explaining that right.

As for remote monitoring, Abbott still receives the Merlin data and maintains their own records. Yes, the outsourced monitoring collects the Merlin data only every three months, but things are programmed to send an alert under certain parameters, in which case the outsource receives it and notifies the Pacemaker Clinic for them to interpret and contact me if needed. That's the part I have to just trust will happen correctly.

All of the settings are the same as the last in-person PM Clinic visit last March. If it means anything in order to comment, it was:
Mode: DDD
Base Rate 60 bpm
Max Track Rate: 130 bpm
Paced AV Delay: 170 ms
Sensed AV Delay: 150 ms
Hysteresis Rate: from 60 to 50 bpm (better sleep!)
Intervention Rate: Off
Percent V Pacing Alert: from On to Off
Search Interval: Off|
V. AutoCapture: from Off to On
V. AutoCapture Paced/Sensed AV Delay: 50/25 ms
V. AutoCapture Search Interval: 8 hours
V. Packup Pulse Configureation: Bipolar
V. Pulse Amplitude: from 3.5 V to 1.25 V - automatic

Thanks again for all the help here at the Pacemaker Club!

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