Help with VT

Good Morning. I’m writing this from the hospital and need some help. I received my Dual Chamber PM 7/26/18 and had no issues whatsoever until 1/05/19. While drying off my dog I stood up and went into VT. It was prolonged (30+ minutes) resulting in a trip to the ER and overnight stay. I was discharged and had a subsequent VT about two weeks later while putting my duvet cover on my duvet  

EP has just told me he thinks my lead may have punctured my septum but says that is not the cause of my VT. He is emphatic that the PM cannot be causing VT. I feel otherwise as both times I’ve gone into it, it has felt mechanical. I also get out without intervention. It seems when I move my left arm vigorously, I start the VT. Can anyone confirm the PM can I fact cause VT? The EP is recommending replacing my PM with an IAD. I am ok, but really feel it is unnecessary. 

 

Thanks 

3 Comments

Paced ventricular tachycardia

by Selwyn - 2019-01-25 10:45:55

Of course there are various degrees of ventricular tachycardia. Certainly, PMs can cause ventricular tachycardia depending on the blanking arrangements between the ventricles and the atria and lack of atrial sensing. These VTs tend to be associated with the upper rate of the ventricles producing 'feedback'. This may explain the 'duvet episode'.

Moving your arm around at top speed will always give you a tachycardia as this movement triggers the PM's rate response. If your VT is associated with the upper rate limit, I expect you may trigger a 'feedback' ( so called LOOP) arrhythmia. 

If you want to read about Loop arrhythmias in dual pacemaker pacing:

https://emedicine.medscape.com/article/159645-overview

is understandable. 

 

VT

by Sibber - 2019-01-29 17:47:50

It is highly highly unlikely that your pacemaker is causing any VT. In general sustained VT without any reversible cause is a solid indication for an ICD. I would definately take your doctors advise.

For the record a PMT as described by the other post is most certainly NOT VT!

Thank You! Proud owner of a brand new ICD!

by NowBionic - 2019-01-29 20:17:15

6 months to the day I received my PM, I have been upgraded! Not feeling so hot right now, but can say the recovery is at least familiar (and seems less involved). I am day 5 in the process. 3 days in the hospital, many tests and still no closer to a diagnosis or as we like to say in IT, root cause. Thank you very much for both of your feedback. It is reassuring to hear from people actually experiencing some of this (even if not exactly your scenario).

 

 

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