First checkup tweaking questions

Hi Everyone
My first post on this site. Already appreciative of previous contributions - great just to know what others have gone through and the questions / concerns they have had.

Last week I had a 2 lead Biotronik Evia DR-T put in - bradiocardia and AV block. Itching to get back exercising (running, cycling, weights) but doctor says the first 2-6 weeks is critical to getting leads embedded well so plan to take it easy.

Would be keen to know what things I should be asking at the first check-up. Would seem important to know
- level of dependence on PM
- voltage delivered - the lower the better for longer battery life?
- battery life - told at post op review the current usage should give 13 years. I'm 52 years old so expecting a few top ups.
- PR interval
Other things?

Also are there options available for the doctor to tweak e.g. I believe they may be able to alter base Heart rate, lower HR for sleep mode, adjust for exercise efficiency. Does any one know about these?

Paul

7 Comments

I have the same

by pace-man - 2014-01-30 03:01:13

Hi Paul, I am from Brisbane and I have the exact same model pacemaker as yours, same amount of leads and same heart problems.
I had mine fitted in October 2013, seems like a week ago, I was just like you , had more questions than answers, I had an appointment with the cardiologist who fitted the pacemaker last week , I had an A4 size list of questions that I wanted answers to, first thing he told me was that I had another eleven years of battery life, my pacemaker is set for 70 bpm during the day and at night between 10pm and 6am it is set at 60 bpm , not sure what the max rate is, but I have since done a stress test and the heart rate went up to 127bpm, I told him that I am going over to Canada later this year and what should I do about the difference in time zones, he said to come in before I go and he will rest the pacemaker while I am away for 70bpm 24/7 and when I come back he will reset it back to where it was, so yes they can change the setting ok.
Another thing I was concerned about was using power tools, corded and cordless, plus arc welders , he said I can use all of these items just make sure the tool doesn't have any leaks and wear rubber gloves and good footwear, I also asked him about using chainsaws and other 2 stroke engine type tools , again he said that they were also ok, another item I was concerned about was if I ever had to have an MRI could that happen ok, he said that this model pacemaker is MRI tolerant , all of the above items only apply to this model pacemaker, I don't doubt that other pacemakers have the same advantages , but I can only comment on this model and brand. By the way welcome to the club, I am sure you will get all of question answered here ok, You can always click on the top right hand corner to do a search
on previous posts. The cardiologist told that there are 5000 Aussies having pacemakers fitted every year, so we have plenty of company , though I must admit I have never met anyone who has one. Rick

Pacemaker settings and information

by golden_snitch - 2014-01-30 03:01:17

Hi Paul!

Was the bradycardia because of the heart blocks or do you have sinus bradycardia in addition to the blocks? Would be important to know, because rate response settings (exercise) is usually only something for people with sinus node issues. The lower heart rate for sleep mode in your Evia only works if you are not in a rate responsive mode or are in the rate responsive mode that uses the accelerometer, and not the CLS sensor. With CLS switched on, you cannot have a lower rate programmed for the night. The base heart rate is normally set somewhere between 50 - 80bpm, I guess most have them at 60. If you have heart block only, the upper tracking rate could be of importance if you want to exercise, but not the upper sensor rate. If you have sinus brady and chronotopic incompetence with rate response activated, the upper programmed (sensor) rate is important, too.

Why do you want to know your PQ-interval? That really only is of interest if you have first degree heart blocks. AV-delay is more important, especially if you have intermittent heart blocks. But it's nothing one absolutely needs to know, it's just a number. The longer the delay, the more time your AV-node gets to do the job on its own. When you exercise, AV-delay needs to be shorter than at rest, but most pacers today automatically shorten it when you exercise. Battery life is important when you are getting close to replacement; right after implant it's probably interesting to know how many years you'll get, but it's only a first estimation, and will definitely change over the years depending on many factors.

Best
Inga

Welcome to the club Paul

by Harrie - 2014-01-30 05:01:38

I'm also an Aussie with the same device for the same problem as you. One thing you might like to know which it took me 6 months to discover is that if your leads fire less than 1% of the time ( ie if less than 1% of your heartbeats in either chamber are initiated by he pm), it will record that as 0%. So in my case with a 0.3% incidence of block before the pm, I'm never going to know if the ventricular lead is firing until my condition worsens to the point where it tips over 1% might not sound like much of an issue but it confused me no end to be told by the cardio tech that the v lead hadn't fired. When the cardio finally told me it didn't report it because it was statistically insignificant I didn't believe him and checked with Biotronik. Sure enough 0% means either the pm has initiated a small number or none of your heartbeats.
I also found the rate response unsettling and had it turned off, and night mode programmed. If you're having your check-ups in a hospital clinic make sure you tell them how you feel. I had to get the cardio to intervene for me, they tend to work off the printouts and if you fall in normal range they are happy, even if you're not.
Royals

Sorry

by golden_snitch - 2014-01-30 08:01:55

Hey Paul!

Sorry, I have been in the pacer "business" for too long, I guess ;-)

Is the brady due to the heart block or would your heart rate slow down even without a block (so, the sinus node, the natural pacemaker in your heart, gets too slow)? It sounds a bit like it's bradycardia due to heart block. In that case, your sinus node should be functioning perfectly and that would lead to the CLS sensor not being needed. CLS is there in case the sinus node fails, but you normally do not need it when you have heart blocks. Also, CLS could very well be the cause of you feeling that your heart rate is too fast. People who do not need the rate response, but have it switched on, often do not tolerate it well. Also, as I said before, with CLS activated you cannot have a night heart rate programmed; the Evia doesn't allow that. If you don't need the rate response because your sinus node works well, I'd suggest that you have it switched off. After all, it drains battery and will lead to a lot more pacing (especially in the atria) then necessary.

Yes, your resting heart rate and your upper sensor or upper tracking rate can be programmed. Upper sensor rate in an Biotronik Evia is, I think, 160bpm while the upper tracking rate - important for patients without sinus node issues - can be programmed much higher up to about 200bpm. I'm sure you'll find out what you need as soon as you get back to exercising regularly.

Best wishes
Inga

Make sure to get

by KAG - 2014-01-30 11:01:29

a copy of your PM interrogation report. It will have all the parameters and settings for your PM on it. You've definitely found a great site to help with any questions you might have. You can see that from the great info above. I think there are people on this site who could design a PM with no problem.

The biggest thing, once you've given yourself a chance to heal and your body to adjust to the PM a bit is: How do you feel? How do you feel at rest and when exercising? That will tell you if you need any tweaks or not.

If you do need tweaks I'd suggest to only change one parameter at a time. If you change to many things at once you won't know what works or maybe made things worse.

Keep asking questions and get back to your normal activities as soon as possible.

Kathy

Another question....

by Terry - 2014-02-01 05:02:10

Why didn't he/she provide for a natural ventricular contraction? see PacemakerPatientAdvocacy.com

Follow up on chest pain

by bjc - 2014-02-06 03:02:50

Several days ago I posted because of the chest pain I was having off and on. My doctor did an EKG and it was normal thank God. She sent me for a chest xray and she is going to call the electrophysiolgist. My question could the lead wires be irritating my heart. Just a thought

You know you're wired when...

You have the perfect reason to show off your chest.

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