99% VP and 47% AP - significance

Hi! I am an 80y old male, and had a Dual chamber STJ Endurity Core pacemker implanted in June-19. My condition was diagnosed as a intermittent heart block. 

At implant the VP was >99% and the AP% was 7.5%.

At my first follow up at 3 months, my VP% was >99% and AP was 47%. My doctor has indicated that these metrics warrant a further investigation. 

Other settings/parameters are 

DDD, Base rate 60bpm, paced AV Delay of 170ms, Sensed AV delay of 150ms

                                    A                   V

Auto Capture                                     on

Pulse amplitude       2.5V               1.625V

Pulse width              0.4mm           0.6mm

Sensitivity                0.5mV           1.5mV

No AMS episodes, AT/AF burden - 0%


Can someone help me understand if my condition is getting worse? Is this a complete heart block? Any recommendatinos to talk to my cardiologist?



Getting worse?

by AgentX86 - 2019-09-23 08:19:29

First, this is a question that should have been asked of your cardiologist. "What dies 'getting worse' mean?"

Second, you should be seeing an electrophysiologist (EP), rather than a generic cardiologist. It's an electrical problem, though there may aslo be a plumbing issue.

It looks to me as if your heart block is complete, rather than intermittent, though you AV delay may be more than your PM is set to provide, so it wins. Also, you have a very high atrial pacing percentage, indicating that something isn't right there, though it appears they haven't discussed this with you.

The difference between the two reports doesn't mean as much as what either says, IMO. You need an EP and have your questions answered by your doctors. I find it very strange that your cardiologist dropped this on you with no further explanation.

different not worse

by Tracey_E - 2019-09-23 09:54:31

Changing the settings can change all those numbers in an instant. If the pacer gives the heart a longer chance to beat on its own before kicking in, it will pace less. Change a setting so it kicks in sooner and it will pace more. If  you suddenly started pacing more after they messed with the settings, that's probably why. As long as you feel good, don't worry too much about the numbers. That's what the pacer is there for, to work when we need it. There is no magic number that is considered good or bad, and many of us pace 100% and are thriving. However, I'll second Agent's advice, if you aren't seeing electrophysiologist (electrician) rather than a cardiologist (plumber), then that's what I would do next. Have a board certified ep check out your settings and make sure they are optimal for you. 

99% would indicate 3rd degree. 2nd degree block often progresses to 3rd degree, or it's possible you went between 2nd and 3rd degree all the time but didn't know. Technically you could call it getting worse, but the pacer fixes it so it doesn't much matter which one it is. 

When we have av block, the ventricles, which make the beat we feel as our pulse, are beating independently of the atria. It's possible to have sinus issues but the av block masked it so we didn't know about it until the av block was fixed. The pacer gets the ventricles beating in sync with the atria, and suddenly we discover the atria was misbehaving also. Again, not really a big deal because the pacer is already there fixing it. It's not uncommon to have a mixed bag of electrical problems in an otherwise healthy heart.

If you feel good, if you like and trust your doc, if your doc is an ep, then I would say let it go and see what the report says next check. If you're the curious sort, if the doctor isn't an ep, then I'd suggest getting a second opinion. 

Not sure about the A PACING

by PacedNRunning - 2019-10-01 02:56:51

I have intermittent 2nd degree. My AV Delay is longer to allow my heart to beat the pacer. Your settings are short. You should have more time to work on your own. Mine is longest 260. Yours is 150. I would pace 100% because my own intrinsic is 160 so the pacer would beat me every time. I think you should address that. I pace as high as 37% AP and 48% VP 


by MrTech - 2019-12-01 11:58:51

You say ‘at implant 7.5% AP’. Was this the time from the implant to the post implant  check, say 24hrs after? These stats are based on time periods.

The stats just state 7.5% and 47% of the time your heart rate tried to go below 60bpm. A 3 month period away from the hospital may be a more true reflection of what ones HR is naturally doing rather than during a check a short time after an implant. If I had a hospital procedure I would suspect my heart rate may be faster whilst in hospital due to emotional stress than the average for the next three months.

The heart rate histograms can also show the natural spread of your heart rate over time as assess if this is normal. This is normally assessed by the professional. The AP% should not be taken in isolation. When we sleep, being relaxed or a naturally low pulse due to fitness, our HR naturally drops or will be lower, and so a HR below 60bpm is entirely possibly, so the pacemaker will kick in to prevent this. Meanwhile while all these HR chances take affect, if one has intermittent or complete heart block, the ventricular % may well be 99-100%.

If one has a pacemaker implanted for intermittent heart block and both ventricular pacing % (after implant and 3 months later) are 99%, one can not assume the HB has deterioted based on these percentages alone. Neither would one know based on these figures alone. All one can deduct from these percentages is that for 99% of the time, the time allowed for your own ventricle to accept a signal has passed and will prompt a ventricular paced event. 




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