6month check up

6 month checkup

by Good Dog - 2016-09-16 15:40:48

I can't address much about your specific Pm and your monitor, because I have a different brand (Medtronic). However, I can say something about the fact that you are paced only in the upper chamber. You obviously needed a duel lead, because your ventricle (the bottom) wasn't always working in-sync with the atrium (top). It is great for you that your ventricle isn't being paced much, because that can become a problem over time. It doesn't always, but heart failure tends to occur more frequently in those of us that have the ventricle paced more often for a long period of time. Again, not always, but it is just a greater possibility.

So your ventricular lead is always tracking even if it isn't being used to fire the ventricle. It will fire when needed, which is why it is tracking. I am sure however infrequent, it does fire occasionally. I can tell you that it is very likely that as you get older, you will need it much more than you do now.  So it will be good for you to ask now much your ventricle is being paced each time you have a checkup. They will give you a percentage, which you can track over time. 

You sound to be in great shape. The more you read here and on the internet, the more you will learn. The Cleveland Clinic website under cardiac care has lots of great information that you can learn from.

I wish you the best!

Sincerely,

David

More details? Ask more questions!

by BillH - 2016-09-18 13:53:40

There are 2 basic conditions for which PM are used. 

The first is from SSS, sick sinus syndrome. The sinus is the main natural pacemaker in the heart. It is in the upper chamber and starts by triggering the atria to contract. With SSS the sinus can be too slow, have long pauses, and/or have a storm of too fast of triggers (atria tachacardia).

After the atria's are triggered the signal passes through the  AV node and then triggers the lower chambers, the ventricles. The are a number of different "heart blocks" where some are all of the signals don't get through the AV node (and downstream) to trigger the ventricles.

Either or both of these conditions can be caused by meds, the effects of heart attacks, side effects of ablations, but in many cases unknow. Many meds that are used to treat arrhythmia can cause either of these conditons (or make them worse).

With SSS, only a single chamber device is needed. But in the US a 2 chamber unit is often used because of the possibility of future heart block.

With heart block a single chamber device can be used to only pace the ventricles. And that is used in some cases. But where the atria is pulsing normally, or can be made to pulse normally with a PM, then a 2 chamber device is used. That causes the lower chamber to beat in sync with the upper and is the most efficienat way.

With a 2 chamber device there is a large number of modes that it can operate in. This is designated by a 3 or 4 series of letters. The most common is DDDR.

In that mode the PM monitors the pulses from the atria and if missing or too slow will pulse the atria, it monitors the signals in the ventrical and if missisng or too late it will pulse the ventrical. And the R is rate response. In those cases where the atria rate does not increase durring effort the PM and increase it Otherwise the PM pulses, if needed, at a set rate.

Based on some earlier messages it sounds like you have a heart block.

In that case the atria (upper chamber) will ideally have 0 pacing, but it likely that one might have some pauses or slow time that would trigger a small amount of atria pacing.

And the pacing would mostly be in the lower chamber or ventricals. With total heart block that would be 100%. But often there is some natural conduction so the pacing would be lower.

What the tech said did not make any sense, no mater what the diagnoses. If the atria is paced 100% and rate response is off then the heart is going to be paced as a single constant rate* and not increase during effort as you report.

(* even without rate response there are several features such as resting/sleep modes that can cause some small changes in PM rates, but not be able to significantly increase HR during effort such as climbing stairs.)

My guess is that tech miss spoke.

But you need to be more active in your care. First find out exactly what you diagnoses is and ask the doctor to explain it. Ask how the pacemaker is suppose to help this. Get a coply of your interogation report each time. And if anything does not make sense or not clear then ask for explanation.

6th month check up

by Pastorm - 2016-09-18 19:53:24

Thanks for your responses! I was told in the hospital last November, that I had a right brundle branch block that became a Complete Block. They kept Me and gave Me a Biotronik Eluna Dual lead Pacemaker, the next Day (as it was Thanksgiving). They gave me a Echo Cardiogram and said the heart looked Great! I don't really know much about My settings, so I thank You for Your advice! I was told I didn't have My rate response turned on! Should I ask for it to be turned on? When I work, I can feel My pulse react and go to about 125. When I stop it returns to about 72. Resting it's about 60-65. At night i have noticed it sometimes dips to 57 or 58! I feel pretty good, but I would like to know more about My situation! I am 65 and in pretty good shape as I walk twice a Day! I tend to be a worrier, so if there is something I am missing, I would appreciate More Advice! Thanks again, Pastor mike

Answer

by BillH - 2016-09-18 20:55:30

I didn't have My rate response turned on! Should I ask for it to be turned on? When I work, I can feel My pulse react and go to about 125.

Personally I don't see any need for it. from what you describe your sinus node is working as desired and with the PM the ventricle is following.

And if it was turned on then it can increase the rate when you don't need it. Naturally, when it is working right, is always better than artifical.