Dr. Appointment Please Advise

Hi everyone,
Thank you all for the suggested questions to ask the dr. at my 6 week checkup. I got "some" answers, but also left with more questions!
( Diagnosed with 3rd degree heart block. Have episodes 2-3 times per year. Asked again today if that was my official diagnosis...she said yes. )

I was told for the third time in a row "no events recorded." I am grateful that my pm is a precaution but it just doesn't add up. I feel harder beats so to say and palpitations. Things that I wasn't feeling before. So at some of your recommendations I began writing them down. But-Dr. told me today that I am pacing 1% of the time so my "events" either aren't happening or are so short it's not recording it or catching it. Also told me I could write it down all I want but she will never be able to tell me the day and time an even would have happened so writing it down is worthless. Just doesn't sound right to me.

She put the halo on the pm and hit a button, she asked if I could feel it....I could feel harder beats. She said she turned the pm on so I could recognize the feeling. But it's the same feeling I have all the time...the ones I was writing down. So she said all the hard beats I am feeling is probably the pm firing off. But according to her....I only pace 1% of the time. How can I feel it fire off....if it's not actually firing...hence the no events recorded?

Asked about the shifting of the pm...she said it was in the same place and basically live with the pain, live with the discomfort....that it's metal in my body. Also what I thought was a scab turned out to be a suture sticking out so she cut it off. Ugh... I don't agree....I think it has shifted up but ok.

Got a printout of my readings. She tried to explain them to me...but I felt very dismissed at that point so I kind of tuned out at that point. So I am looking to you guys to tell me what this means. I will try to type them in the way they are printed...I can't elaborate on any of the info because I don't know what it means. Hoping you guys can help me do that. :-)

Here it is:
Mode-DDD
LRL-50 ppm
MTR/MSR-130/--ppm
A-Sense-0.50mV BI
A-output-3.5 V@0.50 ms
V-Sense-2.5 mV BI
V-Output-3.5 V@0.50 ms
Sensor-off
A-Tachy Response-on
AV Delay (paced) -DYN--ms

Clinical Events-no events

Threshold Test Results
17-Sep 2009 A 0.9 v@ 0.50 ms
17-Sep 2009 V 0.9 v@ 0.50 ms

Counters
Since 17-Sep 2009
AsVs 97% AsVp 1%
ApVs 3% ApVp 0%

ATR Mode Switches 0
ATR Mode Switch Time 0%

Battery Status-good
Magnet Rate-100 ppm
Longevity Remaining @current pacing percentages >5.0 years

Also mailing me a box for calling the pm with a phone....can anyone offer info on that as well?

THANK YOU SO MUCH!
Wendy

2 Comments

Report

by ElectricFrank - 2009-10-21 10:10:25

Ok I'll see what I can make of it.

Mode-DDD: This is consistent with the 3rd degree block. In this mode the pacemaker senses the atrial beats and uses them to time a ventricular pace. This should give you a heart rate that is controlled by your natural sinus pacemaker.

Counters:
AsVs: The pacemaker senses the atrial beats and before it paces a ventricular beat a natural beat is sensed. So in this case the pacemaker is having no effect on your heart. This is occurring 97% of the time.
AsVp: The pacemaker senses an atrial beat and no natural ventricular beat follows within a programmed time interval. In this case the pacemaker issues a ventricular pacing pulse. This is occurring 1% of the time.
ApVs: In this case the pacemaker doesn't sense an atrial beat at a rate above the lower limit so issues an atrial pacing pulse. The pacer senses that a natural ventricular beat occurs following the paced atrial beat so it does not pace the ventricles. This is happening 3% of the time.
ApVp: This is full pacing of the atrium and ventricles. It never happens in your case

So these are the various types of pacing that you are experiencing. One thing to keep in mind is that even though you are not experiencing pacing 97% of the time you still can be having an abnormal heart beat cycle. The only way the pacer has of determining whether a pace is needed is to wait slightly longer than normal and check if a beat has occurred. There is also the problem of competitive pacing where the pacer does not sense a ventricular beat in the allotted time so issues a pace, but at the same point in time a late natural beat occurs. So now you have the natural and paces beat showing up in competition with each other. Very slight changes in heart timing while not a risk can be felt.

One other thing to be aware of. 1% doesn't seem hardly worth it to have a pacer. But keep in mind the 1% isn't necessarily spread out over the time period measured. An extreme example would be going for 99 days with no problems and then having one day where 100% pacing is needed. Without that one day of pacing some of us wouldn't survive to go the next 99 days.

For me the question is whether they are a nuisance or are they very uncomfortable. It is easy early on to have these strange feeling beats alarm us and the result it to create more strange beats. Even though they seem the same as what we were experiencing before the pacer there is one major difference. Now the pacer is there to make sure a beat of one sort or another occurs, where before our heart was on its own and could result in passing out or worse.

hope this helps, keep asking questions.

frank

output

by golden_snitch - 2009-10-22 02:10:15

Hi Wendy!

Frank has explained it all :-)

The only thing I would like to add is: your output voltage is still quite high, 3.5V. Now, this is normal in the first couple of days or even weeks after implant, but about six weeks later it should go down a bit. To give you a comparison: mine is 1.5V in the atrium, and 2.5V in the ventricle. So I could imagine that you feel these "hard beats" because the output voltage is a little high. Yours is more than three times as high as your threshold, and it should usually be only doubled, e.g. when your threshold is 0.9, then the output should be around 1.8, but yours is 3.5. Maybe at the next check-up you can tell your doc to set it lower.

Best wishes
Inga

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