Chronotropic Competance

Does the term Chronotropically incompetant apply to SSS only??

I have complete heart block paced 100% on Atrial only. Set 60 -140 BPM when I first had the PM fitted I was also paced on Ventricle, but for some reason this has now started to work on its own again, so now only Atrial pacing. I believe that the RR is still turned on, as I was not told that it was turned off at my last interrogation. I feel my PM is programed inadequately I feel increased fatigue, SOB during activity; I was fine up til I had the pacemaker fitted and was wondering if this might be the problem.

My heart rate is going up and down on exertion, only ever goes to 60BPM at rest when I go to bed.

Here in the UK they don’t give out much information or printouts and it up to us to ask any questions, that’s why it’s so nice on here with most questions answered for you.

BTW my next six month interrogation is a week Thursday!!
Has anyone got a list of questions that I should ask at my interrogation?

Copied from a post further down the page, shame that all posts don’t automatically go to the top, as a lot of posts are not read if no one goes back down to reads them.

Question for the E.P.
Comment posted by PacerRep on 2012-09-09 01:56.
Just say..."Doc - Am I Chronotropically (Ch-rone-a-trow-pick-a-lee) Incompetant?"

Scenario A
Doc- "yes you are"
You- Ahhh bummer....Now Turn on my rate response!!

Scenario B
Doc "no you are not"
You- Thats Great News Doc!!! Now turn off my rate response!

Thanks Len

5 Comments

Sure thing

by PacerRep - 2012-09-12 08:09:57

So CI only applies to SSS. Its just your body has lost the ability to increase, decrease or maintain your heart rate based on metabolic demand. It kinda sounds like you were programmed to pace in the ventricle (not good if it can be avoided) and then they programmed you appropriately later. If you can just atrially pace, that is your best option. You don't want any V-Pacing if you can help it. But in a patient with heart block this is not an option.

Questions to ask your Doc (I see you already have one of mine so I won't repeat)

1) Hows the battery life? ...Are my battery outputs appropriately programmed (2:1) based on my threshold tests. Please try to optimize my battery to gain maximum longevity.

2) Is my Rate Response turned on. (based on your post here are 2 avenues you may go down)
2A) Yes it is turned on : "Doc, I feel increased shortness of breath during exertion. How do you feel about making my Rate Response sensor more aggressive?
2B) No it is not turned on: "Doc, I have increased shortness of breath during exertion, Do you feel I need rate response because I sure do......Now if he says NO...."O.K. thanks doc, what does my 24 hour heart rate curve look like? If it is flat make sure you don't leave with out RR. If there is a lot of heart rate variability then make your case again to turn on RR if you and the doctor think it will benefit you.

3) Have I had any significant arrhythmia's? Am I taking the appropriate medication to manage these arrhythmias?

I really can't think of anything else based off of what you gave us that would be beneficial to you, outside of just asking questions just to ask them.

And Finally....GET A PRINTOUT! Patients should have a folder with all of their interrogations in them just in case something ever happens, or a change is made and now you feel like crap but can't figure out what the tech changed (because there is no way we are going to remember after a day or two).

Also

by PacerRep - 2012-09-12 08:09:58

I totally agree with you about cycling the posts back to the top of the page. There are a lot of posts I've commented on and it's just too time consuming to go back and look at each one to see if there is a response. So I'm sure I've missed follow-up questions. This would be a very nice feature on the website.

Why pacing?

by golden_snitch - 2012-09-13 03:09:53

Hi!

What I'm wondering is if you ever needed the rate response when you had a heart block only. Usually, people that have a third degree heart block do have a well functioning sinus node, so they do not need the rate response feature. And now that you said you aren't pacing in your ventricles any longer, I'm also wondering why you are pacing at all (in your atriums). Do you have SSS or not?

A rate response switched on when there is no reason for it will most likely just cause problems. Could happen that it increases your heart rate faster than your heart would do on its own, that it is programmed too sensitively.

Best wishes
Inga

Thank you.

by TickTock-UK - 2012-09-13 04:09:18

Thank you both very much for your replies, Yes I will be asking questions next week, I will let you know how I get on. Just to add I am not on any heart medication.

At the last interrogation when she said good news the Ventricle was working on its own now, she also said that I was pacemaker dependant and that my Atrial pacing is 100%. And as I said no mention of RR on or off, it was on, that is why I was asking should it be turned off and would this make me feel any better???

Best Len

Pacer dependent

by golden_snitch - 2012-09-15 08:09:52

You're not pacer dependent when you are paced atrially only. In patients with 3rd heart block one would say that they are dependent on their pacer - though I must admit that even in those I'd be careful to say so, because most of us do have an underlying escape rhythm that kicks in (it's slow, but it's there) when the pacer fails. In your case, should the pacer fail, the AV-node will take over with around 40-60bpm, enough to keep running around. Should the AV-node fail, there is still the His-Bundle or the Purkinje Fibers producing a rhythm of around 20-40bpm or around 10-20bpm respectively.

If you are paced 100% in your atrium, it sounds like your sinus node it too slow, so that you in fact do have SSS. And if your sinus node is too slow, then you need the rate response turned on. Patients with heart block only usually do not need this feature, but patients whose sinus node is not functioning well do.

Best wishes
Inga

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