Book on Understanding Pacemaker Settings

I have had my pacemaker for 10 weeks now for 2nd degree heart block occurring only with strenuous exercise. I have had my settings changed 4 times. I recently had a 2nd opinion at the Cleveland Clinic. They changed the AV Search + from off to on and the Minute Ventilation to "off" from ART only. The other changes are in the Paced AV delay from 80 - 300 ms to 100 - 180 ms and the Sensed AV delay from 65 - 240 ms to 85 - 150 ms. They explained that the pacemaker should now only kick in when I need it. At the beginning I was pacing 13% of the time, then up to 69% and I haven't been back to see what it is now. Would anyone know of a book that is easy to read to explain these settings? I can seem to find anything on line that goes over the page of settings. The Boston Scientific technical person has been somewhat helpful, but I still think there should be information for patients wanting to know what these settings mean. Also, does the pacemaker record an episode of heart block? My doctor said I would feel one strong heartbeat and then the pacemaker would start pacing. I felt about a minute of strong beats and the HR monitor went from 154 down to 72 for about 5 seconds and then came back to where it was. I was wondering if other bikers ever experience this. Also, it would be nice to know if the pacemaker recorded it to know how often it might be occurring.

Thank you for your help. I enjoy this site and reading of other problems that we all have and the support that is given.

Willie G

6 Comments

understanding settings

by Tracey_E - 2014-08-22 02:08:58

Look back through some of the posts by Inga (golden_snitch) and some really old ones by Electric Frank (sadly, he passed last year). Both give great explanations of settings.

One of our members wrote this book. She's also written manuals for most of the manufacturers so she comes at it from an interesting perspective. The book is from 2009, tho, so it may not cover much on minute ventilation
http://www.amazon.com/Pacemaker-Owners-Manual-Pacemakers-People/dp/144868143X/ref=sr_1_1?ie=UTF8&qid=1408728748&sr=8-1&keywords=joann+pacemaker

They don't record heart block like an EKG would but any time you pace ventricle, you are most likely in block.

I don't know why they'd say you'd feel it kicking in. That's very rare. Atrial pacing is different but for ventricular pacing (what we need with av block), all the pm is doing is making sure the ventricles beat every time the atria does. The delay settings are how long the heart has to beat on its own after the atrial beat before the pacer kicks in with a ventricular beat. It'll never go more than a beat, and the signal to pace is minute, nothing we would feel.

Intermittent heart blocks

by golden_snitch - 2014-08-22 03:08:21

Hi!

There are pacemakers that record ECGs of heart block episodes, for instance the Sorin Reply (had one from 2008 - 2014). The Sorin recorded ECGs of 1st, 2nd and 3rd degree heart block episodes. Not sure about your Boston Scientific device.

My EPs say that lots of patients with intermittent heart blocks feel when the pacemaker kicks in. It's because they are not paced most of the time, and then suddenly being paced feels differently. My own experience supports that. Also, some pacemakers have a special mode switch feature that kicks in when a certain number of heart blocks appears within a certain period of time; they do not pace you out of every single heart block. For instance, my Sorin would kick in for 2nd degree heart block when 3 out of 12 consecutive p-waves where blocked. I felt every of the three blocks, and then the pacemaker (ventricular lead) kicked in. And to compensate for the blocks, it kicked in at a faster pace. Definitely felt that.

Inga

Understanding PM settings

by WillieG - 2014-08-22 08:08:50

Thanks Tracy E for the book recommendation. I just ordered it from Amazon. The table of contents did not mention settings but I hope there is information on that topic.

I think the feeling I was describing are the few strong ventricular beats and not the pacemaker kicking in. They changed my settings to allow my intrinsic beat to work, but if it doesn't, then it will pace. This is happening much less frequently as I have been exercising much more and have lost 8 pounds.

Inga, Thanks for the description of your feeling when 3 of 12 p-waves are blocked. I believe my EP said mine would start after one, but it seems to be longer. I have only felt it twice in the 2 weeks since they changed my settings. Do you just have 2nd degree blocks only with exercise? I think I remember you are on your 2nd pacemaker and I wonder if they occur more often as time goes on or have remained at about the same frequency? I enjoy your comments to others and you seem very knowledgeable.

Wilma

Intermittent blocks

by golden_snitch - 2014-08-23 03:08:42

Hi Wilma!

I used to have intermittent heart blocks of all three degrees, and not only when I exercised. Antiarrhythmic drugs made them worse. Due to my atrial arrhythmias I finally had an AV-node ablation in 2012, so now I have a complete and permanent block. But I do remember very well when I had the intermittent blocks, and how this felt.

Even if your ventricular pacer lead kicks in after just one block you might feel a little pause, as the pacemaker gives the AV-node quite a lot of time to get the job done on its own.

"Strong" beats can also always be premature ventricular contractions (PVCs) followed by a compensatory pause. I had those quite often when I started to run, and then after a couple of weeks they just disappeared.

Inga

You might consider

by KAG - 2014-08-23 11:08:52

getting a Clinician manual for your model. I don't know if Boston Scientific does this but I got a 308 page manual for my Medtronics PM. Just went to their site and ordered it. It has everything from installing to tweaking settings to reading the data.

Kathy

Pacemaker manual

by WillieG - 2014-08-25 12:08:32

Great idea! Will see if I can find one for Boston Scientific. Thanks!

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