PACING??

My Guess

by Terry - 2018-05-26 13:28:31

Sounds like your ventricular pacing may be following the atrial rate. See if you are having bouts of atrial fibrillation. Did you know that the long ventricular pause is to perpetuate your own activation? Many doctors have solved this by pacing the heart at the His bundle for a natural ventricular contraction. Unfortunately, pacing like yours that bypasses is known to cause both atrial fibrillation and, over time, heart failure hospitalization. Google His pacing or see His-pacing.org

All the best to you and yours,

Terry

My Guess

by AgentX86 - 2018-05-26 13:59:31

AV node (His) pacing should have results similar to biventricular pacing.  Long-term AF may be a problem with any ventricular pacing but either His or BiV pacing should keep HF at bay (assuming no blocks), since the ventricles beat normally.  HF is a problem with RV only, pacing.

Though he doesn't give much information about his pacing mode, you could be right about the PM trying to follow AF.  That certainly wouldn't be good.  They may want to turn off atrial sensing, at least until a permanent solution is found.  I think I'd want to see someone about this sooner than two weeks.

Pacing???

by maddy - 2018-05-26 15:35:32

Hi.. Its Maddie... I think its in DDD mode if this makes any sense? When I was in tachycardia 132bmp and in qrs ... Nobody mentioned AF.. I went to A and E and this wide Qrs went on for 4 hours .... I had bouts in between where my heart would go into normal beat then felt this pounding . Felt breathless and when I went on the alive core I could see it.. But when I took the ecgs to pacing clinic following A and E they said my heart was pacing and the pacemaker was doing its job.. I didn't feel happy with this so I then sent my ecgs to my cardiologist and he then had his secretary call me and gave me an appointment in 2 weeks time and to say he is classing me as a new patient even though I have seen him off and on over the years?? 

Pacing???

by AgentX86 - 2018-05-26 22:31:37

Yes, 'DDD' makes perfect sense, though doesn't explain your tachycardia. Note, though, that a PM can't slow down the heart, only speed it up.  I'm still surprised that you can't get in to see the cardiologist sooner.  I had a similar deal when I was first referred to my cardiologist for shortness of breath and ended up with a triple bypass, with an ER visit and hospitalization for AF before I could get in to see the cardiologist.  I could never understand the reason for the unnecessarily long delay to see a specialist.

Pacing???

by maddy - 2018-05-27 08:30:26

Hi... All I understand is that my pacemaker was implanted for heart block 2nd degree mobitz type 2..they have set it so the heart now cannot drop lower than 60 bears as the other day it was dropping to 45 bpm and I think I heard them say they have set it to allow the heart to go up to 170 bpm.. Anything else is what my heart is doing by itself..?? Pausing slightly as they are allowing this.. And now this fast rate.. Could be svt? And also the long episodes and short episodes of wide qrs which the pacemaker clinic says is Pacing?  .. I am all a bit confused and I suppose the cardiologist who has now looked at my abnormal ecgs and has requested I see him maybe he will put me in the picture.. I am really not up on all this... Feeling concerned and bit down about it all xx

pacing with av block

by Tracey_E - 2018-05-27 09:37:52

Here's how av block was explained to me when I was first diagnosed... The sinus node (sa) in the atria is the brains. It reads the oxgyen in the blood and raises/lowers our rate accordingly. The ventricles are the brawn, controlled by the av node. It makes the hard beat we feel as our pulse. With av block, the electrical signal is blocked between the sa and av nodes so our atria is beating normally but the ventricles are beating at random because they aren't getting the signal. This is why our pulse drops, only half of the heart is going too slow. 

With us, the pacer mostly watches the atria. Lower limit is how low it can get before it kicks in and paces the atria. For most of us, this almost never happens because that's not where our problem is. With the ventricular lead, it watches for the atria to beat and gives the ventricles a fraction of a second to beat in sync. If it doesn't, then it kicks in with pacing. It sounds like they shortened the time on this for you.

Our ecg's are abnormal when we are paced. Our most normal reading is always going to set off alarms and read as abnormal. My doc once gave me a wallet sized laminated miniature of my ecg, which has come in handy in the ER because they can quickly see what's normal for me. 

When they said it can go up to 170, that's your upper limit and refers to ventricular pacing, how high the ventricular lead can pace. So, if you go for a run and your sinus rate gets up to 180 on its own, the pacer can only get your ventricles up to 170. Ideally this number is set so that  you never get near it. 

The heart can always go faster on its own. The pacer is only a gas pedal, not a brake. All the pacer will do is pace atrial if it drops below your lower limit, add beats if you are skipping, and pace ventricle whenever to keep the heart in sync. 

Yes, it could be SVT. It's not at all uncommon when we are paced for av block to have some svt. It's harmless. If it bothers you or becomes problematic, beta blockers can slow it down but most of us find the side effects of the beta blocker worse than the svt. 

Have they talked about PAC/PVC? They are little half beats between the full beats. They are harmless but they can keep us from getting an accurate pulse and make us feel like we are missing beats. We aren't, it just feels like we are because some of the beats are stronger than others. 

When they tell you the pacer is doing its job, that just means the leads are in position, and it's pacing when it's programmed to pace. That doesn't mean it's programmed the way we need it. As you're learning, fine tuning the programming can take some time. We are all different so they start with a good guess then adjust as needed. It's not at all uncommon to take a few tries to get it right, or to have it right then suddenly a few years down the road it's no longer what we need and it needs to be adjusted again. 

PACING??

by maddy - 2018-05-27 14:42:49

Hi thank you all for all your feed back.. I appreciate it all xx