Heart rate measurement

At my last interrogation, my EP mentioned that I had a few tachy periods with heart rate up into 200's, however, I did measure my own heart rate during those episodes and often measured less than 100's, perhaps some 90's or even high 80's. I used the blood pressure monitor, or take my own pulse manually and/or used the pulse oximeter. And I didn't have any counts that go up to the 200's like my EP mentioned. She went on to confirm that the pacemakers don't lie and have very accurate measurements. My question is why are there discrepancies between my methods which are mentioned above and the pacemaker counts for heart rate? I often hear you folks mentioned on this site that sometimes you folks got your heart rate in the high 100's or even up to 200's. What tools do you folks use to get that kind of measurements?
I mean, I literally count each beat for an entire minute and never got up to 200's nor do my equipment. Any ideas?
I appreciate any suggestions. Thank you.

Duke

12 Comments

Print out of report says..

by Duke999 - 2014-02-18 09:02:09

Snap shot of my report for 6 months says:
Detection:
AT/AF Monitor >171bpm
VT Monitor >150 bpm

Monitored:
VT (>4 beats) 4
Fast A&V 244 Longest 36 sec
AT/AF 112 Longest 4 min

Time in AT/AF <0.1 hr/day (<0.1%)



Any concern with these data, do you think?
Thank you for any ideas.


Duke

Bossy: Your coment made me...

by donr - 2014-02-18 09:02:42

...think - unless you are unusual, you cannot sense the Atrial rate when counting w/ fingers or w/ any of the usual suspects used for home diagnostics. They all sense the Ventricular rate.

The PM senses & reports Atrial & Ventricular rates separately on the download since it senses via the leadss implanted w/i the chambers.

I sorta suspect that the only way you can sense the Atrial rate (other than w/ an ECG machine) is w/ a stethoscope over the heart.

Don

Did you get a printout?

by Theknotguy - 2014-02-18 09:02:46

Duke:

I don't argue that you may have gotten into the 200's. If the PM said you did, you did. Next question on my mind is how long? If it was for a few seconds you probably didn't even know it. I'm thinking another call to the EP to get clarification or see what was on your printout.

I went into an a-fib session with a heart rate up into the 140's - a-fib with RVR. Felt like I was going to cash in my chips. So if you were in the 200's for any length of time I'm thinking you would feel like you were in pretty bad shape.

Since I haven't had much experience with the rapid heart rate, I'll bow out and see what other comments you get.

Like I said before, thanks for alerting me to the APP setting on my PM. I've had several sessions where the APP kicked off so I'm guessing it's prevented some sessions of a-fib for me.

Hope you can get some answers and feel better.

Theknotguy

Atrial rates

by Bostonstrong - 2014-02-18 09:02:55

Was she talking about your atrial rate? Those can be much higher than your ventricular rate. You would have an altered level of consciousness with a vent. Rate if 200' that rate simply doesn't give your ventricles time to fill with blood.

Yes..

by Bostonstrong - 2014-02-18 10:02:08

That is correct. You can't count an atrial rate by taking a pulse. That is too fast to count listening with a stethoscope also.

High heart rate

by Elleninminn - 2014-02-18 10:02:42

Those are pretty good numbers compared to mine on my latest pacemaker interrogation report. You were in AF 4 beats.

I think the top two numbers you list refer to parameter settings on the monitors. My settings are the same as yours.

I'm hoping that my next report will be much better since I'm using my CPAP machine and getting treatment for sleep apnea and haven't noticed any afib for the past three weeks.

Correction to above

by Elleninminn - 2014-02-18 10:02:49

When I posted, most of what I wrote was deleted for some reason, so the first sentence makes no sense.

I think your numbers are good, compared to mine, anyway. Your time in AF was <0.1 a day. Mine was 1.8 hours per day. I had several episodes that lasted more than 24 hours. The PM breaks those down to separate episodes, even if I went back into NSR for 30 seconds or less, so it counted a total of 2,771 AF events! You had only 4 incidents of VT greater than 4 beats. I had 17. And your report was for six months I think; mine was for three.

asfasfa

by boxxed - 2014-02-18 11:02:42

An illustration:

Example A:
(Beat) --------------------- (Beat) <--- Interval of 1000ms (60bpm)


Example B:
(Beat) ------- (Beat) <--- Interval of 300ms (200bpm)


The pacemaker only needs to see Example B a few times (or maybe even once, not quite sure), for it to declare that you had tachy that went as fast as 200bpm.

asfasf

by boxxed - 2014-02-18 11:02:58

Pacemakers count beat to beat. So you may have had a little run that clocked @ 200bpm (or 300ms between the two beats). That may be why you didn't catch it. It'll note the fastest it's ever been between a few beats and note that as the maximum rate.

Report interpretation

by golden_snitch - 2014-02-19 03:02:57

Hi Duke!

I would interpret the report as follows:

AT/AF Monitor >171bpm
VT Monitor >150 bpm

Those are the detection rates, so an atrial tachy has to be 171bpm or faster in order to be detected by the pacer as an atrial tachy. A ventricular tachy needs to be 150bpm or faster in order to be detected.

Monitored:
VT (>4 beats) 4
Fast A&V 244 Longest 36 sec
AT/AF 112 Longest 4 min

You have had four VT episodes which were longer than four beats. Usually, pacers differentiate between "sustained" and "non-sustained" VT; a sustained is longer than 30 seconds. Would be interesting to know at what rate they were running. However, studies indicate that about 20-25% of all device patients have short runs of VTs detected every now and then. But in most patients this never leads to any serious VT or even sudden cardiac arrest. So, if your doctor didn't say anything about the VT episodes, they probably were short and slow.

Furthermore, you had 244 episodes when your atria AND ventricles were running at fast rates, the longest episode was 36 seconds. Again, it does not say anything about how fast your atria and ventricles were actually going. But 36 seconds is really short.

Finally, you had 112 episodes of atrial tachy/flutter/fibrillation, the longest lasting four minutes. Again, no rates, so it's hard to say if those were atrial tachys or atrial flutter or atrial fibrillation. Does not mean that your ventricles were beating fast, too, could be that you were in aflutter or afib, and the ventricles were beating at a normal, slightly faster or slower rate. So, when the doctor said you were having episodes of 200bpm, she might have, as Tracey suggested, meant the atrial rate, which is the reason why you didn't feel anything.

Time in AT/AF <0.1 hr/day (<0.1%)

Not worth mentioning, you are spending less than 6 minutes per day in atrial tachy.

All in all, I'd not worry about these results. Your tachy episodes are really short. You might have even had these before you got the pacer, just didn't know. Now the pacer picks up everything, but not everything is worth worrying. You see that in so many device patients.

Best wishes

Inga

P.S. I remember you asked if I was a professional: No, I'm not. Just been an arrhythmia patient for about 15 years with many, many different arrhythmias, lots of ablations, and pacemaker surgeries.

Thank you all..

by Duke999 - 2014-02-19 04:02:22

Thank you for your explanations. Your responses helped tremendously.
Theknotguy, I'm glad the APP setting is helping you.
Bostonstrong & DonR, thank you. What you said helps me to understand a little more.
Elleninminn, I hope and wish your next interrogation report will provide better readings. Thanks for your input.
Boxxed, your illustration is great. It makes sense to me.
Thank you that clever illustration.

And Golden_Snitch, what can I say. Your intuition and knowledge is fantastic. Thank you so much for deciphering those numbers. I wish my EP or Medtronic tech can take the time or nice enough to explain to me like you do. I appreciate you very much.

I wish you all well.

Duke

Duke..

by Bostonstrong - 2014-02-19 06:02:28

You may call me Bossy...

You know you're wired when...

Your favorite poem is “Ode to a Cardiac Node”.

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