Fine tuning

At my post implant (2nd PM) appt. with my EP, he performed a procedure no one else ever has. He explained having both ventricles "fire" at the exact same time may seem a worthy goal but, all of us are different. He took me to the echocardiogram tech along with the PM device tech and performed the following: With the Medtronic "mouse" hung over my PM, he would instruct the device nurse to change the timing (+or- 10, 20, 30, 40 etc milliseconds) while watching the Doppler report of how well the ventricle was filling, then emptying. This procedure took nearly an hour to "fine tune," but I was able to easily do my 4 mile trot at 4 mph on the treadmill a few hours later!

--Dave--

5 Comments

Good EP!

by golden_snitch - 2015-03-12 01:03:20

Great that they gave you an echo guided CRT optimization! At the clinic where I'm being seen, they have an ultrasound in the pacemaker clinic, and it's used mostly for CRT patients. Not that uncommon, but I guess some doctors just don't take the time to do it.

Tracey, you can't get this optimization, because you have dual-chamber device, and not a CRT. There is no way to optimize how your left and right ventricle beat. Theoretically, one can fine tune a dual-chamber device with echo guidance, too, but practically it's rarely been done. It's only done in patients who suffer from a bad case pacemaker syndrome (atria and ventricles out of sync).

By the way, the ventricles never beat completely insync, not even in a 300% healthy person. There is always a short delay. In patients, who benefit from a CRT, however, this normal delay is prolonged which then leads to a total dissynchrony of the ventricles and consequently to a reduced EF.

ah!

by Tracey_E - 2015-03-12 01:03:32

Ok, Inga, that makes more sense! I didn't catch the CRT part.

Sounds like

by Grateful Heart - 2015-03-12 05:03:27


Your new EP is a keeper.....good for you.

Inga: I'm a little confused. You said "In patients who benefit from a CRT, however, this normal delay is prolonged which then leads to a total dissynchrony of the ventricles and consequently to a reduced EF".

Did you mean a PM? I have a CRT-D and in my case, my EF and ventricle pacing has greatly improved.

Always appreciate your vast knowledge and educating us. Just want to be sure I am not missing something.

Grateful Heart

same question for inga

by capecod - 2015-03-12 11:03:11

as grateful heart. if we benefit from crt-d, how can there be desynchronization? I'm still trying to learn and understand all of this.
thanks inga.

awesome!

by Tracey_E - 2015-03-12 12:03:55

How clever!! In all the extensive fine tuning I've had over the years, including being a case study for the manufacturer, they have never done that for me. Very smart. And instant gratification, too.

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