Pacemaker dependent

Not pacemaker dependent, but

by Gemita - 2024-10-10 16:43:28

Don’t be confused.  You have partly answered your own question that because your father’s natural rate is in the 40-50 bpm range and the pacemaker has been set at 60 bpm, he will always be paced close to 100% of the time.

Dependency means that if the pacemaker is turned off, your father would probably not survive for too long without urgent medical support/care.  This would not perhaps be the case for your father who has bradycardia, so his own natural pacemaker at 40-50 bpm could sustain his life.  However with a low pulse of 40-50 bpm, he would not feel too well without pacing support, so he will still need to be paced to have a quality of life.  A heart rate of 40-50 bpm is too low for him to feel well at his age.

So just to recap, your father could still survive without a pacemaker - hence he is not regarded as pacemaker dependent in the true sense of the word, but that doesn’t mean he doesn’t need a pacemaker for his bradycardia (slow heart rate).  I hope that makes a bit of sense.

I hope your second opinion has proved valuable?  What was the outcome about lead revision?

Second opinion is valuable.

by smopace - 2024-10-10 17:32:04

The doctor confirmed his has leads fracture and both leads have fracture. But since he is not pacemaker dependent, he can wait for battery used up or his lead is broken. It will be lead capping not extraction due to his age. Before that, he needs to do venogram to make sure his vein has enough space for new leads. Is venogram safe?  If his vein has no space, then transplant a new pm in other side of body and leave the current one abandoned. 

dependent

by Tracey_E - 2024-10-10 20:03:10

Different doctors define dependent differently. 100% paced is not necessarily 100% dependent means if they turn it off, the heart won't beat enough to keep us going. Most of us are not dependent, even if we pace 100%. 

Venogram

by smopace - 2024-10-10 21:17:48

Has anyone done Venogram before? Does it use the same dye as implanting PM? Is it safe

I have had bilateral venogram

by Amyelynn - 2024-10-10 21:44:19

Your dad should be able to be fully awake for venogram not sure what dye is used but it is outpatient procedure with intervention radiologist (or that's who did mine but imagine EP could also perform)

my arms were both quite sore after the procedure and I also experienced pain during the procedure (but the doctor then gave me pain meds via IV and I passed out for remainder of the procedure)

you have like an X-ray screen above you and screen doctor can see to get a good look at the inside of your veins. 
I love that they want to do this before the replacement procedure so they know what they are in for and plan moving ahead less risk and better outcome for your dad.

happy you got second opinion!

not being 💯 dependent also means your dad will not need temporary paving from femoral artery when he gets his pacemaker replaced and new leads put in.... I think? 🤔 

Thank you for sharing, Amyelynn

by smopace - 2024-10-10 22:55:25

I am more worried about alergic reaction. Is it the same dye used in pacemaker implant or CT contrast?  If they are the same, then it is fine. 

Safety of venograms

by Julros - 2024-10-11 00:59:38

Yes, the same dye, and iodine-based, radio-opaque dye is used for a venogram. I had one during the procedure to upgrade to a CRT-D with no problems, whatsoever. I had had a CT angiogram the preceding year, so it was known that I had a narrowing of my subclavian vein, and the venogram was done to assess for the feasibility of removing my RV lead. And hurray, that was done without issue. 

Of course, as with any medication, there is the chance of an allergic reaction, such as hives or anaphalaxis. Luckily, medical faciilites have emergency drugs available and can respond promptly. This happened to my sister and they treated her as soon as a reaction was noted. 

I have often wondered about the "pacemaker dependent" label. I have seen both applied to my self, but my EP insists that I have an underlying rhythm about 30. I think the pacer tech says I am dependent because they only turn the pacer down to 40 during checks and still don't see an intrisinc rhythm. 

Best wishes to you and your dad. 

Dependency

by piglet22 - 2024-10-11 04:15:10

Technically, you are paced, you may or may not be dependent as the others have said.

The device records the degree of pacing which is what the interrogation reveals.

Dependency is is a description of what might happen if the device wasn't there.

It's not helpful if the physiologists use both terms interchangeably. It's the same with device change. Sometimes they say it's a battery change, sometimes a generator change.

Pacemakers are sealed single use devices, so you get a new battery with the device change.

Dependency becomes important when you are disconnected from the device during a replacement, where the patient falls back to their condition if it were untreated.

I can't say my last replacement was comfortable and I had been prepared for external pacing.

I would describe my condition as 100% paced and a high degree of dependency. It could or could not be life threatening without the device, it would certainly be uncomfortable.

Your father's pacing team will have a good idea of what might happen without PM support.

Edit 13/10/2024

A good indication of dependency is the oximeter or BP monitor.

If when relaxed, you get a steady heart rate at the IPG base rate with little variation over a long period of time, months, years, you can be fairly sure that the pacemaker is doing the work, and not you.

By variation, I mean with an IPG base rate of 70 BPM, readings of 70, 71, and 69 BPM would indicate dependence.

It's important to be fully relaxed when taking readings.

IV contrast dye

by Rch - 2024-10-11 17:23:16

As to the IV contrast, any allergic reaction can be managed with medications, but the contrast mediated nephropathy is the one that needs closer observation. I am sure the Radiologist will check the kidney functions before and after the procdure and advise him to drink plenty of fluids  Please discuss that with your providers.

Venogram

by Tracey_E - 2024-10-14 10:21:28

Venograms are perfectly safe. I'm not sure what dye they use but I reacted to the dye on a contrast CT so they loaded me up on antihistimes for the venogram. No reaction, but I slept most of the day. 

yes and no

by dwelch - 2024-10-24 01:25:55

My experience is the same as Tracey_Es comment I have had the same doc say I am and am not.  100% is not only normal but desired for me I have complete heart block, if the pacer does not report 100% there is a problem somewhere, but, every interrogation they turn it off and there is a strong natural rythm there, just broken.  With heart block you are dependent in that you are likely to eventually die from it if not treated, but likely not to instantly die. And with the pacer then you are just normal, fixed, done, period.  Also you are paced 100% of the time which I think some folks might consider dependent, but IMO percent does not define dependent.

"pacemaker dependent" is one of those terms that IMO is not really defined.  Some folks (int he profession, and certainly outside) use one defiinition and some use another.  A blurred line, etc.