First Check Up coming in Early January

I had a PM installed in late August 2009; Type 2 Buddle Block / Dual Lead, Medtronic ADDRL1. I am now due for my first hospital checkup in early January.

I realize today how little I knew about PM's before one was attached to me for life. For an engineer with a graduate degree I am embarassed to admit this.

Since August I have learned a few things, but could some of you put forward a few ideas, questions, that I should ask? Anything thoughts or suggestions from your experiences will be greatfully appreciated.

Regards,

Ron

4 Comments

Am A Novice

by ppt - 2009-11-12 07:11:34

I am a newbie (only 1 year). Software engineer also with a graduate degree and have Right Bundle Branch Block (RBBB) that goes into intermittent Complete Heart Block (CHB) and have a dual lead Medtronic. Guess we are colleagues in more ways than one.

What I have learned is absolutely nothing compared to some on this site who have many more years of experience. But here is a start. And those who have more experience please chime in and correct me where needed.

The heart is a complicated organ. It is the only part of our body that is not controlled by the brain. The heart has 2 sub-systems: 1) pumping (oxygenating and distributing blood through the body) and 2) electrical (when to pump and the pumping signals). This site's members' issues are electrical (bad signal, bad timing of signal, blockage of signal etc) which is why we need a PM (or ICD). Not to say we also couldn't also have pumping issues (arteries building up plaque etc).

I downloaded the Medtronic Manuals but they were difficult to read without knowing all the terms - so slowly come up to speed on all the terms. It is a whole new language .. truthfully an entirely new language.

The settings on the pacemaker are so important. Ask for and keep the initial interrogation report and then, if settings are changed, the final interrogation report. This way you can begin to learn the settings and what they mean. Someone on this site (wish I could remember who because it was great advice) recommended keeping the most recent on you in case it was ever needed.

It is really important that you keep track of when you do not feel well, e.g. short of breath (SOB), dizzy, nauseous, how you respond to activity like getting up from chair or just plain walking, palpitations etc. The Drs seem to think that they put in a PM and that is it. So it is up to you to monitor how you feel and report to Dr. Details are important.

And it is very important to keep hydrated. I learned that the hard way !!

I recommend the book "The Nuts and Bolts of Cardiac Pacing" by Tom Kenny. Great book - I got mine on half.com I think, or Amazon.

Also the web - amazing what is on the web. If you put "heart electrical system" into google search one of the sites that comes up to select mentions an animation of the electrical system. It is a good starting point to understand the electrical system of the heart. And use the google search to put in terms like "bundle branch block" and "chronotropic incompetence" etc etc.

At first I learned about the low and high limits for the pacemaker (the pacemaker will not let the heart exceed those settings), whether rate response was on or off (DDDR as opposed to just DDD). Then I would just google the terms on the interrogation report .. just kept learning. Its fun to learn and we keep learning more and more.

Hope this helps some. Good luck with your checkup :-)


A few more suggestions

by ElectricFrank - 2009-11-12 11:11:35

The most important thing is to request a copy of the pre and post programming reports. The pre report will have a lot of information on your heart and the pacemakers response to it. It also has the settings that have been in place.

The post report shows the results of the tests they will run during the test, and then the new settings.

There are few settings that come up a lot and can really affect how well the pacemaker is serving you.

Since your condition has to do with Bundle Block the Mode should likely be set to DDD. If it is set to DDDR it means the rate response is ON which you don't need. This is a feature that attempts to set your HR based up activity level. The problem with it being on is that your own natural pacemaker is likely doing a good job of pacing the atrium and the rate response tends to compete with it. DDDR is the default mode that Medtronic ships the pacers in. If the doc doesn't change it at implant you are stuck with it until the first programming session. I discovered mine was DDDR after about 3 weeks and insisted on a followup session to DDD. Made a big difference.

Another similar item is the Upper Tracking Rate. This sets the maximum paced HR that the pacer will track the atrium. Again the factory default is usually 120 which for someone like you who likes hiking is very limiting. I couldn't walkl briskly into a wind here in the desert without feeling it. The problem is that the limit is enforced by making your heart skip beats. At the same 3 week point I insisted that mine be increased to 140 and then a month later on up to 150. I don't hit the 150 rate, but I don't want it in my way. Like I told the cardiologist, if a bear is chasing me I don't care if I exceed my target HR.

Hope this helps. If you are having any symptoms at this point, post them and maybe we can suggest some other things to look at.

frank (another engineer)

Thanks to PPT and Electric Frank

by PadWC2 - 2009-11-16 05:11:15

I apologize for not thanking you immediately on receiving you two very detail responses. You two guys are just as busy as me which is the reason we have pacemakers so no excuse is offered.

I am extracting lines from each of your comments and have started my list.. "Nuts and Bolts of Pacemakers" at $50 (Amazon) says something about the demand for information. I thought I would try my local library first this week and then off to Amazon.

The theme which both of you offered is get the 1. pre-history befor they go about making refinments and 2. Don't assume that the first setting when installed are the right ones for you....be pro-active all the way.

Again many thanks, and I will report back in January.

Regards,

Ron


My first in hopital checkup / adjustment

by PadWC2 - 2009-12-03 08:12:42

PPT and Electric Frank:

I had my first 3-month check up and adjustment. I need to look through the Interrogation Reports, but wanted to thank you again for your helpful hint. I did drop the R from the DDDR and had the upper limit moved from 120 to 140. In a few days I'll send along the other stuff.

Wanted to thank you first off however.

Ron

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