PacerRep

Report says AMS entry 24 counts 12EGMS High Ventricular Rate(5 cycles @175bpm) 14counts 14EGMS noise reversion 0counts 0 EGMS. AMS entry 640/190 duration 4:04:20:56,183/101 0:00:00:44, 197/97 0:00:03:14,208/100:01:24:56,202/107,0:01::30:24 just a sample I have more. My EKG says Atrial Fibrillation Demand Pacing. Left axis deviation,RBBB with left anterior fascicular block. Inferior infarct-age undetermined. Posible anterior infarct- age undetermind. Lateral T wave changes are nonspecific. In and out of High ventricular from 6-14-12 until 6-18-2012. This was not my initial interrogation I went into see Cardio as my heart felt like it was going to jump out of my skin.
Duke

3 Comments

Your Welcome

by PacerRep - 2012-09-07 01:09:49

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PacerRep

by 2558duke - 2012-09-07 01:09:50

Thanks for your help.
Duke

Thanks

by PacerRep - 2012-09-07 12:09:35

So your Ventricular episodes are very short (5 cycles...or only 5 heart beats). I didn't realize you have A-fib. This is very very common, sometimes that fast heart rate just conducts down really fast, which is most likely the cause of 12 of your 24 EGM's you describe...don't worry about it.

The 640 is still an issue, The good thing is your device is appropriately documenting it as Noise and it is mode switching (thats when the device changes the way it paces to ignore what it is seeing, in your case a fake heart rate of 640bpm).

the inferior infarct you had most likely stemed from your right coronary artery (if your going to have one thats the best place). That can irritate the heart where the scar is (left from the heart attack) and cause extra beats in the ventricle. I doubt this is the case with you, its probably the A-fib adding the extra beats, would need to see a 12-lead while your having the extra beats to determine that, but its really a moot point with only 5 cycles. This is also probably why you have a Right Bundle Branch Block (RBBB).

In and out of the high ventricular rates for those 4 days could mean anything, depending on where they originated from and how long they lasted (12 lead required again).

From a programming perspective, I would be most concerned with that noise on your atrial lead. Why is it seeing it? Have them start trouble shooting it, they will start with decreasing the atrial sensitivity and if that doesn't work try changing the pacing vectors form Bipolar to Unipolar. If that doesn't work, and you are in A-fib all the time, just shut the lead off and fix it during surgery when its time for a battery change. It looks like the noise is lasting a while based on the info you gave, you have a 4hr episode there that has to be the A-fib, but some of the short ones that are a second or 2 are probably the noise. Your best coarse of action is to demand an answer for the noise and to be programmed around it.

the rest of the info you gave does not correlate to the issue.

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