To Smitty -- HR, Sotalol, PM Settings

• by PKite
• 2013-03-10 06:03:32
• General Posting
• 1037 views
• 0 comments

Smitty, like ElectricFrank, DonR, Tracy, along with others. has been a real help to those of us who are new to the PMC. I've had a private messaging with him that me -- during those communications I sent him the following message. It is being posted (with slight changes) with the idea that it may benefit others. We learn from other peoples experiences.

"Hi Smitty -

Thank you for your quick response. Glad to see that you are still at it. You are a vital part of the input to the Pacemaker Club. Keep up the good work.

I've had some struggle with getting my cardio to respond to the problems I'm having. After 6 months, my cardio called in an EP. I was having problems that sent me to the ER three times -- with the result generally being, on the part of various Md's and cardios, "your ekg looks good and your pacemaker is ok, we don't know what the problem is." The first ER had the PM tech increase my ventricular voltage to 3.5v. and turned on the Minute Ventilation on my Boston Scientific pacemaker.

In retrospect, my opinion is, that that change resulted in me being incapacitated on some occasions resulting in two more ER visits. Less than a month ago, I got the cardio and the PM tech to change the V. voltage of 3.5v back to 1.6v and turn off the Minute Ventilation. That resulted in a real improvement -- I was no longer being incapacitated to the point of having to go to the ER. However, I didn't feel up to par.

The next thing that became obvious is I was having a number of periods during the day when my heart rate was running about 45 bpm (I almost got tired of being told "with a PM your heart rate is never lower than 70 bpm”--I wasn't debating the actually heart rate but the fact my apparent rate wasn't what it was expected to be with my PM -- something is still wrong) . At this point, my cardio finally called in an EP (I hadn't had an appointment or seen an EP from the time of my PM implant to the time the cardio contacted the EP (a 6 months period).

Last week I met with the EP. He said that my problem might be from PVCs and he suggested that he might need to increase my sotalol dosage. At that point I told him that the low heart rate especially occurred after taking a sotalol dosage.

His response was "Stop taking sotalol [it takes three days to get the drug out of your system] and see what happens, and let me know how you feel." (I had been taking sotalol since my implant.) FINALLY, someone who is willing to look at the situation. He also made an appointment for me to wear a Holter Monitor. I get it tomorrow -- he wants to verify for PVCs.

From my standpoint, the result of discontinuing sotalol (after three days) was "this is the best I've felt for some time." Mobility has improved, but there are still many periods of low heart rate (likely caused by PVCs); however, living with PVCs is better than taking sotalol. Today, the mobility factor let me spend a couple hours this morning walking about Busch Gardens as well as replacing our post office box in the front yard in the afternoon – better than what has happened in the past weeks.

Finally, one point of this reply to you is that about a week after I wear the Holter Monitor, I am scheduled to see the EP again. As you did, I'm going to ask to have my Lower Rate Limit changed from 70 bpm to 80 bpm to see what happens.

Thank you again for your time and input.

Pkite"