Decision to make

I have had my PM for 1 1/2 years now. It seems that I now have a cholce to make and I could really use some advice. I know that I should call my EP, I am hesitant at the moment.

For the past year and a half, my PM was set to
DDD mode where it paced my ventricle due to intermittent second degree heart block. I recently wore a monitor for two weeks and found out that I feel pretty good with the PM set in VVI or as I like to call it "backup mode" with the PM set to kick in if my HR goes below 40. I can even exercise in this mode. My dilemma is this. Although I have no pain or discomfort, a few time per day, I can feel the heartblock and am reminded of my failed ablation and awful cardiac experience. I am also reminded that my heart is damaged, whereas when the PM was running, I was pretty unaware. Every night before I go to bed, I feel some acrobatics in my chest, however no pain just annoying.
However, I feel pretty good and am saving my battery which was running out pretty quickly. My question is, Is it better to have my heart doing the work on it's own? Is it healthier physically (if not mentally)? Does heart block ever improve?
Any advice is greatly appreciated,
Dahlia

6 Comments

Decision

by pmredhead - 2008-02-14 08:02:30

Hi,

I understand what you're going through. I just had my pacemaker put in a couple weeks ago. I have congenital heart block with 3 degree which means i've had it since birth. I went to my doctor and he told me to get a pacemaker right away because i wore a heart monitor 24 hours and it showed that my heart stopped in the middle of the night and i was having the symptoms almost everyday.
I don't rely on my pacemaker It just kicks in when I need it. And when my heart gets weird then the pacemaker takes over. Especially when my heart rate goes below 40. I'm not a doctor but I know with having congenital heart block all of my life, i know that it will never improve. But I think you should talk to your doctor and tell him what's going on and he'll probably adjust it to where you are comfortable. For me it helps both physically and mentally.
Constance

Response turned off

by heckboy - 2008-02-14 09:02:17

Hi,

I had my rate response turned off because I liked the idea of the PM working off of my own rhythm. I wish I knew that was an option when I got it as it took months of experimenting to get there. Why some one didn't say " since you have normal sinus activity, I suggest trying your PM with the rate response turned off" is beyond me.

Same Thing

by Carol - 2008-02-14 09:02:33

Hi Dahlia, I also have intermittent 2nd Degree with the PM set to kick in when my HR dips below 50. I too can feel when the block sets in and feel the weird palps. I am one of the few who can feel the PM pacing my right ventricle and really don't much like the sensation. My doctor at one point thought about pacing me 100% of the time just so I'd get accustomed to the sensation, but then decided it wasn't, as he put it, "what we signed on for". For me, I prefer to let my heart do the work when it can because at least I have stretches where I can feel perfectly normal...of course that means feeling the Block kick in (which happens freq for me, like whenever my HR reaches about 90, and as you said it reminds me that all will never be normal for the rest of my life. I don't think a block can reverse itself unless it's due to medication or something similar, but I'm not a doctor and certainly don't know all the possibilities. I guess the bottom line is to think about how you feel the best and go that route, at least I think that's what I would do. Good luck, Carol

Mode choice

by ElectricFrank - 2008-02-14 11:02:26

In the VVI mode the ventricle is paced at the lower rate and ignores the atrial rate. Since you have normal sinus rhythm you really want to have the ventricles synchronized to the atrium for good pumping efficiency. The Medronics 701 I have has a feature that can be programmed in DDD mode called Search AV which determines your normal delay between atrium and ventricle and waits just slightly longer be pacing the ventricle if a beat doesn't occur on its own. This way pacing is inhibited when you have normal activity, but when you need it DDD pacing happens. I hope this makes sense.
I keep hearing people trying to reduce pacing as much as possible as though it is better. They forget that inefficient cardiac rhythm robs the whole body of a normal supply of blood and could be damaging other organs, or at least affect quality of life. The only positive effect is to increase battery life.
One other thing: the funny feelings in your chest may be PVC's rather than the pacer kicking in. I get these periodically and having my own ECG I can check what is happening and PVC's are the most common.

frank

Mode Choice- Electric Fran

by Dahlia - 2008-02-15 08:02:19

I have been in DDD mode for over a year now. It seems that my normal delay between atrium and ventricle is milliseconds longer than my pacemakers longest setting, so it was in pacing my ventricle 100% of the time.

I am not sure if reducing pacing is the answer, that is my question essentially. I guess the answer may be to ask the doctor how much my type of inefficient cardiac rhythm may be impacting my other organs and my body in general. However, I also want to know "is the only positive effect of pacing on my own (with intermittent block) to increase battery life"? Are there any other benefits?
Dahlia

PVC... LMNOP?!?

by heckboy - 2008-02-15 11:02:32

For the remedial here (like me), what does PVCand DDD mean?

Frank, I will ask at my next appointment if there is a similar feature to Detect pacing rhythm in my St Jude.

Good post!

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.