Questions and more questions

Update:

Post op day 24 for PM insertion (Revo). This is my second post.
I'm still having occasional episodes of chest pressure, palpitations and pain. I have a right pleural effusion with pleurisy which started 24 hours after PM insertion but told it is completely unrelated to the PM insertion. Cardiac enzymes good. No one checked a BNP. Echo is okay. PCP started me on steroids against the Cardiologists opinion. Says I should just take Motrin (which has 0 effect). I only see red cause I'm too young for this and no one seems to have an answer for Why?

EKG says suspect anterior/inferior infarct but I do not see any EKG changes (ST) personally. MD says CT angio done 3 years ago show 0% calcium score, so no reason at ALL to think I have CVD or follow up with other testing. He was vague during PM interrogation and says I need to just forget about it and not focus on it! I'm told I need to go back to work. Not excited about lifting 100+lbs only four weeks Post op. Hubby thinks I should see an EP...I'm so confused and not feeling well.

Q: How does the pacer pace during arrhythmias (I have multiple arrhythmias)?
Example: junctional/juctional tach?
Q: Can the Revo be programed to pace me out of an arrhythmia?

Thanks in advance for your opinion,
D

3 Comments

Pacemaker & tachycardias

by golden_snitch - 2013-10-10 04:10:09

Hi!

Why did you get the pacemaker?

A pacemaker cannot do anything about tachy-arrhythmias, it can only "watch" them. If you have a complete heart block and an atrial tachy-arrhythmia occurs, it can switch modes from dual-chamber pacing to ventricular pacing only. That way, what happens in your atria is simply ignored, and the pacemaker paces your ventricles at a steady & appropriate rate. What can also happen is that the pacemaker goes into a 2:1 block, permitting only every second electrical signal from the atria to get to the ventricles --> atrial tachycardia of 180bpm will then lead to a ventricular rate of 90bpm. But if you do NOT have a heart block, the pacemaker cannot pace you out of your arrhythmias. There are some pacemakers that are equipped with special features to suppress/reduce atrial fibrillation, but nothing for atrial tachycardia such as junctional tachycardia; and the afib suppression rarely ever works. So, sorry, but no, any kind of fast arrhythmia will just inhibit the pacemaker, so that it can only sense but not do anything about it; pacemakers were made to treat bradycardia, not tachycardia.

The EKG sounds like one of the automatic diagnosis that the EKG software comes up with. It's often wrong. I would never ever trust that software. If a doctor has looked at the EKG and said that it looks fine, I'd rather trust him than the software. Actually, I think the EKG software has never made a right diagnosis in my case, it always diagnosis lots of nonsense. So, don't worry too much about this.

Best wishes
Inga

Answers anyone?

by Danise - 2013-10-10 05:10:40

Hi Inga:

My official diagnosis is: SSS, which is why I had the pacer put in. I also have paroxysmal afib, flutter, occasional SVT and runs of up to 15 beats VT.

My normal underlying rhythm is poss. wandering atrial pacer - P's are inconsistently shaped and R to R is irregular with a HR in the mid 50's. When I look at the strip documenting my SSS I am apparently in SR in the 70's although I have no distinguishable P wave for 24 seconds until there is one P and then an inverted P and then I Brady down to 30 with no distinguishable P's. I was incredibly symptomatic and have had this result in syncope in the past or stabilization measure during surgery. I was just thinking that I was junctional tach degrading to junctional because there isn't a distinguishable P and the ST has varying morphology as well (hiding the P?). MD thinks Afib and/or it does not really matter since I was brady and the pacer will stop my free fall. I have been put on Atenolol to help keep me from going Tachy but I'm not sure it has helped yet since sometimes I feel like I'm jogging while sitting on the couch with a HR in the upper 90 low 100's which can jump to 150-170 unpredictably. I'm wondering if I have anti-grade conduction or an aberrancy that is causing some of my symptoms....can the pacer detect pacemaker syndrome or anti-grade conduction and stop pacing the ventricles?

D

No, it can't.

by golden_snitch - 2013-10-11 04:10:16

Hi!

The pacemaker will not detect pacemaker syndrome in the sense that it gives some kind of warning, and it cannot do anything about a retrograde VA-conduction. If you google pacemaker syndrome, you'll find the signs and symptoms that point to it. The VA-conduction can be tested during pacemaker interrogation, but again this is nothing the pacemaker will detect on its own and treat.

I have had a retrograde conduction, resulting in a pseudo-pacemaker syndrome with AV-dissociation (mostly atria and ventricles beating at the same time or ventricles beating first, then atria). My dual-chamber pacemaker could not do anything about it. At first it helped to program the base rate a little higher, at 70bpm, because then the junctional or idioventricular rhythm was overdriven by the pacemaker. Worked for a while, then this rhythm became faster, so we tried all kinds of antiarrhythmic drugs. Worked for another four years, but then I needed AV-node ablation.

Not sure why you think you have a pacemaker syndrome or retrograde conduction. Sounds more like you "just" have some kind of atrial tachy. Also, SSS can mean that your sinus node is sometimes too slow and sometimes too fast (tachy-brady-syndrome), so your SA node itself could also be causing tachycardia.
The chest pressure and pain could still be related to the pleural effusion and pleurisy. I had pleurisy once, and it took a while to heal, and it hurt quite a bit. You're only three weeks post implant, in addition to the pleurisy, some of the pain could be caused by the implant itself.

Best wishes

Inga

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