Pacing too much in the lower chamber

I haven't been on this site in a while, as I've been doing pretty well with my pacer. I've had my pacer for 3 1/2 years. I also have POTS. I got my pacer due to severe bradycardia (30's - 40's). My low rate is set at 70 and I feel pretty good with that. I saw my electrophysiologist yesterday and he was concerned that I'm pacing too much in the lower chamber...an increase from 20% 6 months ago to 60% at my most recent pacer check. He indicated that over time this could cause problems for me, even though I'm feeling fine right now. He has ordered an ECHO, since it's been 2 years since my last one and has ordered a "special" pacer check to have my pacer turned off briefly, while doing an EKG to check my underlying rhythm (I'm not 100% pacer dependent). My question is, how concerned should I be and what could be causing this?
Thanks!

4 Comments

Opinions arew like noses...

by donr - 2015-01-23 08:01:22

...everyone has one but some are just uglier than others!

It appears that no one thinks enough of their own nose to stick it into this discussion, so I'll give it a try.

Lessee now, the echo will tell him if the two ventricles are synchronized properly & you still have a good ejection fraction. One of the hazards of excess RV pacing for a long period of time is loss of that synchronization. When this happens, they install a three lead CRT device with or without pacing and /or Defib capabilities. Grateful Heart & Sparrow claim to have one of these. There are a lot of them around.

The second half of the test, the "Special ECG" is to lay you down, while under a cardio's direct observation, & briefly stop the ventricular pacing for a "Short While." You report that you are NOT pacer dependent - that means that you originally had low Ventricular pacing percentages AND, most likely evidence of an "Escape Rhythym," where some part of the ventricular control system takes over at a slower rate than the SA should it fail. Problem is that the AV waits a short while to kick in before it takes over the pacing job. The wait varies from person to person & the ECG machine will record everything electrical that happens while you are waiting for the AV to wake up & do something.

I just reviewed your previous posts & see you have Brady/Tachy Syndrome (or is it Tachy/Brady?) If you go into the Tachy mode too often or for too long a period, the escape rhythm will evidence itself along w/ the high Atrial rate. He has to turn the PM (pacing you at 70 BPM) off in order for the AV escape rhythm to show up (Probably down in the 30-40 BPM range.)

How concerned should you be? Well, it probably will not feel very good to you - perhaps light headed, dizzy, & near or into syncope. Most likely a bit worse than you felt w/o the PM pre implant. But at least you will already be lying down; you will know to expect to feel funny because they will tell you when they turn the PM off. Yes, there will be a fear factor because of the unknown. Unfortunately, they are going to have to watch it for a few beats into the escape rhythm showing up so they can record what everything looks like, so you may be stuck in that mode longer than you like.

Since you are being V paced 60% of the time, they should not have to wait long for some sort of arrhythmia causing your escape rhythm to show up.

Would I voluntarily take such a test? Are you kidding - I'm a coward at heart (pun intended).

Your EP will probably tell you it's "No big deal." If he does, suggest that he trade places w/ you on the table!

Face it - they will KNOW exactly what is happening in REAL time & can turn the PM back on instantly.

Doesn't sound like fun, but I've had worse tests than this

OK, fellow nose wearers, let's see what yours look like. Are they uglier or prettier than mine?

Anyone been through it? C'mon, blow me out of the water. I did exactly what Calvin Titus said "I'll try, sir!"

Donr

Don

Has your EP considered an...

by donr - 2015-01-23 11:01:08

...ablation?

Sorta last ditch after meds fail you, but if you have the RIGHT cause for the A-Tach, it can work. Golden_Snitch writes about ablations all the time. She had several that apparently did not work & cautions that they can only be used for A-tachy under the proper conditions of the origin of the cause of it.

Hope all goes well in the testing.

Donr

Thank you!

by DawnM - 2015-01-23 12:01:31

Don,
Thank you so much for taking the time to reply, and so thoroughly! I'm not so concerned about the ECHO and the pacemaker check as I am the increase in the V pacing and what the long term effects may be. My EP is a wonderful doctor and has been treating me since long before my PM was implanted, and I trust him completely. He did mention to me about the possibility of having to insert a third lead, but hoping he won't need to go down that road. With improvements in technology, there are much more sophisticated devices since mine was implanted 3 1/2 years ago, but the unknown is scary to think about. After my pacer check 6 months ago, showing 20% V pacing, we did a trial of stopping Dogoxin, so that I wouldn't need to pace as much, but my tachy episodes were unbearable so I resumed. We talked about decreasing my beta blocker this time, but that will cause increased tachy episodes too! There's no easy fix here and I'm way too young (42) to not have my heart pumping properly! I'm hoping I still have a very long road ahead of me.
Thanks again!

Ablation

by DawnM - 2015-01-24 01:01:36

I have discussed ablation in the past, but my tachycardia has always been sinus rhythm and it is pretty well controlled with meds (though the meds cause me to pace more). My EP indicated that ablation would not resolve my tachycardia.

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