Interrogation Report today

I wonder if anyone can shine some light on the report I got today?

// Clinical Status: 10/30/13 to 05/15/14

Mode Switches: 16,101 (Percent of Time: 3.1%)

Atrial High Rate Episodes: 4,902

Episode Trigger: Mode Switch >30 sec

22:41 longest. >400 (max A). 105 (max V)

12:32 fastest >400 (max A). 101 (max V)

AS-VS 11.2%, AS-VP 0.3%, AP-VS 87.8%, AP-VP 0.8%, MVP On.

Event Counters: PVC singles 1,204, PVC runs 29, PAC runs 297,615.

Ventricle High Rate Episodes: 0

((Funny thing is the new tech said I only had 4 Afib episodes in the last 6 months. Looks to me that she was wrong about that !?))

7 Comments

numbers

by Tracey_E - 2014-05-15 08:05:43

Atrial High Rate Episodes: 4,902 = you do a LOT of racing. That just means going fast, not fibrillating.

A= atria
V = ventricle
S = sensing (pm watching)
P = pacing
So, most of the time (87%) you pace atrial

Lots of pvc's but most everyone does.

Hopefully Don or Inga will chime in, they know a lot more about this than I do :)

I'll Try, sir!

by donr - 2014-05-15 11:05:08

OK, I've copied your note & will add my answers right after your question; NOTE: I rounded off numbers so I could easily manipulate them in my head!!!!!

// Clinical Status: 10/30/13 to 05/15/14**** You last were down loaded on 10/30/13. Today's date is 5/15/14. The interval between those dates id the period over which data was stored. Your PM's memory was wiped clean to start storing more data.

Mode Switches: 16,101 (Percent of Time: 3.1%)***** You didn't tell us what mode your PM operates in, but whatever it normally is, it switched to a different mode 16,101 times to improve the PM's capability to help your heart function better. Probably because of high rate episodes.

Atrial High Rate Episodes: 4,902***** You had this many Atrial HR episodes - based on the PM's criteria stored in its memory. Usually, the criteria is established by your Cardio/EP, & it's around 175 BPM. I have a Medtronic Versa & that's my criteria.

Episode Trigger: Mode Switch >30 sec***** This is how long the PM waits after detecting the high rate (or whatever) to switch modes. You may or may not feel it happen.

22:41 longest. >400 (max A). 105 (max V)***** Not going to touch this one - need to look it up; not exactly sure what the shorthand description means.

12:32 fastest >400 (max A). 101 (max V)***** Not going to touch this one - need to look it up; not exactly sure what the shorthand description means.

AS-VS 11.2%, AS-VP 0.3%, AP-VS 87.8%, AP-VP 0.8%, MVP On. Tracey explained all but MVP - that's a Medtronic term describing an algorithm that manages Ventricular pacing (MVP = Managed Ventricular Pacing.) This is where the Mode Switch comes in - the PM changes modes when you have Artial high rates to preclude the Ventricles trying to keep up & cause inefficient pumping action. Also saves wear & tear on Ventricles & reduces the amount of time the ventricles are paced. There are problems that may develop in the Left & right ventricles being synchronized if the right one gets paced too often.

Event Counters: PVC singles 1,204, PVC runs 29, PAC runs 297,615. PVC singles = Piker!!!!! 1204 of them in more than 6 months is an average of less than 100 per day. About 4-5 per hour. They don't become a problem till your PVC fraction of HB's approaches 30%. 29 PVC runs? Depends on how long they were. Lots of long ones can lead to further complications. 29 - about 5 per month. Chump change, trust me on this one. 300,000 Premature Atrial Contractions - now that's a LOT. These are probably what prompted the mode switch. that's somewhere near 1500 per day; about 60 per hour; about 1 per minute. Again, not specified as to length of the runs. To put this in further perspective - the heart beats about 3 million times per month. 6 1/2 months is about 20 MILLION beats. Now that's a basketful. 300,000 PAC's is a pretty small percentage of 20 Million. It's about 1.5 percent.

Ventricle High Rate Episodes: ***** Your Ventricles are doing quite nicely, thank you!

Hope this helped

Donr

Thanks Don & Tracy

by Shepheart - 2014-05-15 11:05:19

I will chew on this some more, but wanted to say a quick thank you for your help. Much appreciated.

I did look up Atrial High Rate Episodes (AHRE) and found that they are not exactly the same as Afib but are associated.

Shepheart

Not much to add

by golden_snitch - 2014-05-16 02:05:20

... except that MVP is NOT for atrial high rate episodes. It is a mode designed to reduce ventricular pacing in patients with intermittent heart blocks. MVP and the mode switch occuring for atrial high rate episodes are two different features. The mode switch for atrial high rate episodes is a switch from a DDD or AAI mode to ventricular sensing/pacing only, so VVI for instance. MVP on the other hand is a mode switch from atrial pacing only (AAI) to pacing both, the atria and ventricles (DDD).

The odd thing is that the report states that your mode switch episodes account of 3% of the time, while your ventricular pacing percentage is just about 1%. Makes me think that when you have Afib, the pacemaker does switch modes, but it does not need to pace the ventricles (only senses them) most of the time, because your AV-node is working. A mode switch for atrial high rate episodes does not have much of an effect with a functioning AV-node, because the node lets impulses coming from the atria pass through.

Also, atrial high rate episodes in most pacers do include the flutter and fibrillation episodes. There are some other models that differentiate between high rate and AF, but I think most store all these episodes under atrial high rate.

Inga

Inga & I have a disagreement -

by donr - 2014-05-16 08:05:57

I'm sending her a Pvt Msg so we can sort it out privately. Answer when we are finished.

Donr

Thank you Inga

by Shepheart - 2014-05-16 09:05:53

For sharing your knowledge and experience, I appreciate you help in understanding my report.

I forgot...

by golden_snitch - 2014-05-17 02:05:22

Atrial high rate episodes

22:41 longest. >400 (max A). 105 (max V)

12:32 fastest >400 (max A). 101 (max V)

Can be either hours and minutes or minutes and seconds. Atria were fibrillating ( rate > 400bpm), while the ventricles were reaching a max rate of 105 or 101.

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