Need some information

I went to a new cardiac doctor today for a second opinion and I met with him and a Medtronic Rep. I have an Adapta 2 lead pacemaker. When the rep looked at my settings he said my DDDR should be AAIR = DDDR and changed it. Does anyone have or have had this setting and can offer some information on it. My doctor did say that since I don't pace in the ventricles that the new setting is more beneficial. Since the change I keep feeling skipped beats, so I'm not sure if the change is causing it. Thanks!!

5 Comments

New Settings

by ElectricFrank - 2012-03-28 01:03:08

I'm away from home til the end of the week and don't have my manual with me to look up the effects of the new settings. If you don't get an answer from someone else remind me.

frank

New Settings

by ElectricFrank - 2012-03-28 01:03:11

I'm away from home til the end of the week and don't have my manual with me to look up the effects of the new settings. If you don't get an answer from someone else remind me.

frank

AAIR to DDDR

by golden_snitch - 2012-03-28 02:03:00

Hi!

I have the equivalent setting in my Sorin Reply DR. It's a special kind of mode switch from AAIR to DDDR. Basically, with this setting the ventricular pacer lead will not kick in for every single heart block. It will wait until it has detected a certain number of blocks in a certain period of time, before it starts pacing the ventricles. This mode was designed to minimize ventricular pacing in patients who have intermittent heart blocks. A study has shown that it reduces ventricular pacing down to around 2%, while in simple DDD-mode (pacer kicking in for every single heart block) patients would end up with 30-40% of ventricular pacing. This is also due to the fact, that if you are in DDD mode, a so-called "AV-delay" is programmed: the time the AV-node has to kick in, if it doesn't the pacer will. In many, many patients the AV-delay is programmed to be quite short, not giving the heart much time to do the job on its own. So, lots of people have much more ventricular pacing than they really need. A single heart block is no problem, there really is no need for every heart block to be paced.
Now, to reduce VP is very important, because several other studies indicate that the more ventricular pacing one has, the likelier you will end up with heart failure and the occurence of atrial fibrillation.

So, since your pacer now doesn't kick in with every single heart block, those skipped beats you feel might very well be heart blocks. I feel them, too, but have got used to them. Believe me, in the longrun it's better to feel some skipped beats than to develop heart failure because of too much ventricular pacing.
I know that I'm still safe, because as soon as I'll go into 3rd degree heart block, the pacer will not wait, but kick in after just two blocked p-waves (no chance that those blocks cause pauses, no fainting, the pacer will kick in in time). In 2nd degree heart block, my pacer waits until it has detected 3 blocked p-waves out of 12. In 1st degree heart block, it waits till it has detected 7 prolonged PQ-intervals. Not sure what the Medtronic algorithm is, but I think 1 out of 2 p-waves has to be blocked in this Medtronic MVP mode.

Hope this helps.

Best wishes
Inga

Thank you!!

by tammy11 - 2012-03-28 07:03:47

Thank you, Frank and Inga!! Inga, your information helped a lot and I appreciate the time you took to send it to me. Frank, I always look forward to reading your responses. Thanks again. This is the most helpful group. I'm 41 with 2 small children and a husband and this pacemaker stuff has been really stressful trying to get the settings figured out and it didn't help that I had to switch doctors after 5 months of the pacemaker being put in.

Tammy

Very Informative

by Casper - 2012-03-28 10:03:28

Great question Tammy11, I really learn a lot here.

I find Electric Frank and Snitch extremely informative.

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