Sorry to be a bit dumb !

I have a Replant Op on the 14th Dec to prevent the little sucker from breaking out ( Glenfield Leicester UK)

Can you help me decode these notes:

" Mr TM is pacing 5% of the time. On looking at his ECGs he is A paced V paced, at other times he is A Paced V Sensed. As he is pacing 5% of the time the question is whether we can improve the longevity of the battery...........If we can try and change the Pacing Regime to prevent Ventricular Pacing that may be helpful.There is a suggestion on one of the ECGs of a possible Atrial Tachycardia and I wonder if the sensing on the Atrial Lead is also an issue....."

I kind of get this stuff but I dont understand the bit about "Pacing Regime and V Pacing " also would I know that I was A-Tachy ..ie could I sense it myself. Finally I'm worried about the "sensing on the Atrial Lead...issue "

Are they going to dig a lead out ?

This is probably easy-peasy for a lot of you out there. I've always steered clear of the Techy-Numbers stuff in the past.

The PM is a Sorin DR 2550 60 bpm min 2 years old. Me,I am a fit 62 yr old "alleged runner "

Best wishes and thanks Tattoo Man

6 Comments

asfasf

by boxxed - 2012-12-06 06:12:36

They're optimizing battery life. Since you are intermittently ApVs and ApVp they're wondering if they extend the AV Delay they can let your own heart beat come through and prevent ventricular pacing (which can bad and should be avoided) if it's not necessary. Say for example it takes 200ms delay inbetween your atrium beating and then your ventricle beating on it's own. Say your device is set @ an AV Delay of 180ms, where if it sees an atrial beat, it will wait 180ms before it V-Paces and forces a ventricular beat. That means that it will pace 100% of the time and it would be pacing 0% of the time if it just waited 20ms longer.

If only the AV Delay was set to longer like 220ms and the device was programmed to wait just a bit more your own heart beat would come through and alot of unnecessary pacing could be avoided. That's an example of what they're considering. This is of course if you don't have some quirky stuff like rate-related blocks or intermittent blocks, but even then extending AV Delay may end up shaving off some of that V-Pacing %.

The next thing is them debating if you are having "real" Atrial Tachycardias. Sensing issues are not uncommon. And, sorry if I sound callous or indifferent, but they're also not that big of a deal (most of the time). Sometimes the atrial lead senses activity from the ventricles and double counts it. So instead of the normal "duh-dum" heart beat:

(Abeat-Vbeat) (Abeat-Vbeat) (Abeat-Vbeat) (Abeat-Vbeat)

The device could read it instead as:

(Abeat-Fake A beat - V beat) (Abeat-Fake A beat - V beat)

Since the device is now reading TWO atrial events for every ONE ventricular event (even though it's actually just counting the ventricular event twice), it calls it an atrial tachycardia. Whether it's a real atrial tach or a fake one that is just mis-sensing is something for the tech/physician/rep to figure out.

There are a handful of other ways for sensing issues to occur, but that's the most common one in my experience.

Morning T'Man !!!

by sue uk - 2012-12-07 06:12:18

Just wanted to wish you well for next Friday, l am sure you will be fine, not sure if the medical team working on you will survive though but l am sure they will be offered counselling of some sort :-))
All the very best, Sue x

Good One Sue

by Casper - 2012-12-08 12:12:43

That's funny Sue, I'm sure the medical team is gearing up for Mr. TM.

Wishing you a quick recovery Mr. TM.

Casper

It was good to hear from "Boxxed, he always has good advice."

Thank you gals !

by Tattoo Man - 2012-12-09 07:12:22

Sue and Kate..how thoughtful of you. This time next week I hope to be back home and busy irritating Mrs TM, with, hopefully my PM back where it belongs..ie..not in my armpit !

Cabg...what is all that stuff about shoes ?. I dont recall ever telling PMC about my predilliction for Kitten Heels and Espadrilles.

Still, now its out in the open I do feel much better

Best wishes to all

TM

By the way,..I am thinking of changing my Avatar name for the New Year..I'm a little concerned that Tattoo Man is a bit 'old school'...and besides I actually have no tattoos at all....I'm contemplating 'Fat Bob' after Robert Smith of The Cure...any ideas ?..I'm happy to go along with a committee opinion,...ever the democrat, me.

hi

by kate2 - 2012-12-09 08:12:36

hi, im kate and live in spalding .lincs. which hospital do you go to? good luck for friday. kate

Kate2

by Tattoo Man - 2012-12-09 11:12:14

Hi Kate, we are pretty well neighbours...I live just outside Newark. My hospital is Glenfield..Leicester, one of the best Cardiac Centres in the country..

Thank you for your good wishes. I'm taking my computer with me so that I can bore all at PMC with a kind of 'commentary thread'....this will be in a Booker Prize winning 'Film Noir / Fly on the wall' kind of report..gritty and un-flinching. Any International Awards that might come my way will be flogged off and the proceeds given to the American Charity for the Support of Cardiac Surgeons hitting Hard Times...or ACFTSOCSHHT for short

Tattoo Man

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