Stopping in....

Hello everyone!! It has been a while since I have stopped by, but I wanted to say Hello :) I have been doing well, to a point and I have been doing whatever I wanted. The PM has not really affected my lifestyle, although there are still a few twinks that need to be worked out.
So, on that note, I do have a question.. I have the Biotronik Evia Dr-t implanted 10/29/14. When I go over bumps/potholes, dips etc in the road, my HR goes to 150 in less than the blink of an eye. When I do anything that should make my HR go up, I get very short of breath/breathing heavy. I currently have a magnet to record these events and will go back to the pacer clinic next week. She said I am not the only patient at this point that feels this, there are a handful of us and if they can't get the settings right, I may need a new one.
Does anyone else have this issue? Has anyone of heard of it happening? I know Inga seems to have a lot of info on Biotronik pacers, is she still posting?

Thanks all! I hope everyone here is adjusting to their implants and are doing great.

5 Comments

Evia & rate response

by golden_snitch - 2014-07-20 09:07:02

Hi!

Yes, I am still posting :-)

First of all, if your Evia reacts to bumpy roads, it sounds like you have the motion sensor (accelerometer) switched on, and not the CLS (closed-loop stimulation) sensor. Your pacer has both, however, if you need to choose one of the two, they do not really work together (other that the CLS "consults" the accelerometer in periods of rest or kicks in when the CLS can't work, for instance when you have a mode switch due to atrial tachycardia). What happens if you tap on the pacer, does the heart rate increase, too? If so, it's really running on motion sensor, not CLS.

Secondly, your settings seem to be way too sensitive. Could be that the acceleration is programmed too fast; there are different options with regards to how fast it shall increase the rate when you exercise, and the most sensitive setting makes your heart rate go from base rate to max rate in like 10 seconds or so. Could also be that the "sensor threshold" is programmed in a way that the sensor reacts too rapidly even with little exertion. When the motion sensor is on, a "low" or "very low" sensor threshold can lead to this. You need to set it higher to reduce the aggressive response.

Also, do you know if the "learning function" (called "automatic sensor gain" for the motion sensor) has been activated? It's nominally off, but it should be switched on, so that the pacer can kind of figure you out and adjust the sensor gain accordingly.

It would be helpful to know what your rate response settings are. Do you have a printout of the latest report? If so, please post it here, and then I can probably make more suggestions.

Inga

rate response

by mom0f6 - 2014-07-20 10:07:20

Hi Inga! Thanks for responding. I did, at one point have the CLR turned on, but I could feel every heart beat, missed beat, pvc etc so we did turn that off and turned on the other one. The threshold is set at the highest sensitivity it can be set on right now. (they tried medium and that really did not work for me) I do not know about the learning function though.
I just tapped on the pacer maker and it did not seem to make my hr go up, do I need to tap hard? (it is still very sensitive to touch)
I don't have the latest printout unfortunately.
Thank you!!
Terri

Terri

by golden_snitch - 2014-07-20 10:07:22

Not sure, but recently another Evia patient with motion sensor on told me that, if she itches on the pacer site, the rate increases, and several others here with motion sensors have said the same about tapping on the pacer. But if you know for sure that you have the motion sensor on, then don't worry about the tapping.

The CLS needs some time to figure you out and adjust. It can be really nasty in the beginning, causing lots of tachycardia. I'm currently going through that period of optimization again as I had a setting changed a week ago, and the CLS starts to learn from the scratch again, whenever you change something. So, I had a couple of really bad days with lots of inappropriate tachycardia and much more PVCs than I usually have. But it optimizes automatically really well. You just need to give it time, and even when it's reacting very sensitively, you need to go on with your daily routines and exercises. It optimizes from day to day. I have heard quite a few stories from doctors and patients who said, they switched the CLS off again after just a couple of days, because it was causing tachycardia. That's really bad, because it's a great sensor, if you give it some time to optimize.

The problem with the roads is a typical accelerometer problem, no matter which manufacturer you have (so, a new pacer won't help because most use accelerometers only). It does not only pick up upper body movement, but also "vibrations" and "shaking". I'm not sure that this can be resolved completely by changing settings. You might want to give the CLS sensor another try to get rid of this problem.

You said: "When I do anything that should make my HR go up, I get very short of breath/breathing heavy." Does that mean that when you are moving or exercising your heart rate doesn't go up as it should, which then causes these symptoms? If so, that is probably because you now have the "very high" sensor threshold, which makes the sensor respond only to rather vigorous exercising. I guess you have that setting because of the problems when going over bumpy roads? Sounds like it doesn't really help, but in addition creates the problem that, when you are active, the sensor doesn't respond well at all.

So, again, maybe give the CLS another chance. It won't react to bumpy roads. If you decide to go for it, it's important to know that with regards to the sensor threshold, it's the other way around with the CLS sensor: A high threshold means higher rates, a low threshold means slower rates. Yes, I know, not really user friendly ;-)

Has your cardio asked a Biotronik rep to come in and help with the adjustments? Does your cardio know that she can activate a 20 minutes test when she changes rate response settings? It's a great feature, because it shows her immediatly how the sensor responds. All she needs to do is to activate the test, then have you walk for 20 minutes (or run or use the stairs or whatever), and then look at the results. I'm not sure, but I think the programming device will then, with the help of the data from the 20 minutes test, even make suggestions how to optimize the settings.

Good luck!

Inga

Thank you!

by mom0f6 - 2014-07-20 11:07:13

Thank you again Inga!
I will ask about the CLR again on Thursday. I had it turned on for 4-5 months, but if it just takes longer to adjust, that might be better for me.
It was switched to the RR because of the PVC's etc. It was the Biotronik rep who made the changes, and she is in the pacer room most everytime adjustments are made. I will certainly ask about the 20min test too! I did not know about that one, although we did do some walking/fast walking before they adjusted my settings to high.
I am a personal trainer, and I exercise pretty vigorously 6 days a week. When my heartrate gets up (to the 150 setting) which takes the appropriate time to get there, I then feel as if I can't breathe and I can't go on, I have to stop and wait for my HR to drop again. (which is a new thing, but it only takes 30-40 sec to drop back to 60bpm).
I am learning to live and adjust to my life to these feelings, I just needed to know if I should keep trying on setting changes!

Have a Great day
Terri

pacer appointment

by mom0f6 - 2014-07-24 06:07:36

It appears I now have (or have always had) AVNRT and Far-field issues going on.
I am glad we were finally able to see something with the magnet because I was feeling a bit crazy, even though I knew what I felt!


Thanks again Inga for your responses!!

Terri

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