Device will be interrogated

My friend is going to see the doctor next Friday. This is the scheduled visit to have his ICD interrogated. I need your help on what he needs to bring up during this visit. Here are my thoughts. Please feel free to add, or correct :)

I was thinking about the rate response in his ICD. I don’t think it is on right now. I feel it might be helpful to turn it on. Right now his lower setting is at 60. Several doctors have recommended he lowers it to 50. He is reluctant. This time I think he will meet them half way and try 55. It might help him sleep better because right now he feels it pacing him at night and it wakes him up from his sleep. Correct me if I’m wrong, but I think the rate response will help him when he’s been sitting around too long and needs to climb a flight of stairs for example. The sensor will sense that he’s about to engage in activity and will give him that extra push he needs since his beta blocker is keeping his heart rate low.

I want him to ask on how to go about getting an MRI now that he has an ICD. Is it totally out of the question? He has never had one, and does not want to get a CT scan. If there is no way to have an MRI with his current ICD, when it’s time to replace it, can it be replaced by an MRI compatible ICD? Is there such a thing?

To sum it up, here are the three things that I have come up with that he needs to bring up:

1) Activate the rate response
2) Set the lower setting to 55
3) Ask about the possibility of an MRI

Am I forgetting anything? Any other suggestions?

FYI his diagnosis is hypertrophic cardiomyopathy...

2 Comments

PM Checkup

by SMITTY - 2011-04-10 02:04:37

Hi Anjelica,

Here are my thoughts on the message for your friend.

1) Activate the rate response - Before doing this check his heart rate then take him out for a fast walk or a stair climbing exercise. If his heart rate increases then I would guess there is no need for the rate response right now. The natural PM will increase his HR when he starts physical activity and will probably respond to his need for an increase in HR faster than the rate response.

2) Set the lower setting to 55 - I doubt seriously that he will notice the difference in 50, 55 or 60. Those are the points at which the PM will step in to keep the HR from going lower. So long as the heart's natural pacemaker is keeping the heart rate above that set point the PM does nothing but monitor his heart function.

If he can feel it during sleep now he will probably feel it in his sleep with a lower set point. I say follow the Dr suggestions here, but ask them to check other settings on his PM. It could be anyone of hundred things that need changing to keep him from feeling his HR when trying to sleep.

3) Ask about the possibility of an MRI - Most PMs in use to day will not tolerate a MRI. However I understand Medtronic (and maybe others) are now marketing, or getting ready to market one that is MRI tolerant. I have to add that I don't understand his reluctance to have a cat-scan. If it were me and the cat-scan was suitable for the diagnosis of what ails me, then I would prefer it.

Am I forgetting anything? Any other suggestions? - I'll leave "other suggestions" for others.

Good luck,

Smitty

Pacemaker settings

by ddoherty - 2011-04-14 02:04:24

I had a lot of trouble sleeping with the lower limit set to 60. Eventually it was lowered to 45 and I get a great nights sleep now

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