Tachycardia that's not fast. One in a million--that's me
Is there such a thing as Pacemaker Mediated Tachycardia without the tachycardia?
Background: back in the early days after I got my little friend, I developed pounding, pain, and if I tried to push through it instead of sitting down, I would collapse.
After two years of steadily getting worse, I was finally diagnosed with PVC induced PMT. (But only after I demonstrated the collapsing part while in the EP's clinic.) Since there was no heart block, the sinplest solution was to turn off the ventricle lead.
I did well for about 3 years, but then developed LBBB and heart block Type 1. The Type I heart block led to fainting, which neccessitated turning the ventricle lead back on. The EP did some very fancy programming to reduce the chance of PMT.
Again, I did well for 18 months to 2 years, but then started to have PVCs that I really felt, followed by my heart feeling "shaky" for a few minutes. The problem was tolerable until early September of this year, when I was walking the dog on a very hot afternoon, and I felt what felt just like the PMT I used to have--including feeling extremely weak and close to collapse.
I have already ranted about the subsequent visit to the clinic. I was told most emphatically that I wasn't having PMT and my PVC burden was low. Subliminal message: why are you bothering me lady when you probably don't know a PVC from a swallow-tail butterfly. Grudgingly, the PA acknowleged that even though my "burden" was low, I was symptomatic, and prescribed diltiazem.
The diltiazem seemed to help. I went from 3-4 collapsing episodes a day, to a couple a week.
When I was seen for my regularly scheduled device check, this NP listened to me carefully. She noted that during the Holter monitor test, when I had reported symptoms, I was being paced in the ventricle.
She was able to pace the ventricle and reproduce the symptoms--at 90bpm. Which technically isn't tackycardia, but without question, it's pacemaker mediated.
In the last week, the symptoms have gotten much worse suddenly. Instead of lasting for seconds they last for minutes, and once, for almost an hour.
So, oh wise ones, clearly something needs to be done. But what? I wish I had a better understanding of PMT, so that I could discuss it more intelligently. I also realise I have never seen the actual printout of the Holter monitor. Would it be reasonable to ask for it?
What questions should I be asking?
BTW, the NP said the current programming is so extraordinary as to be incomprehensible to the ininitiated. "Never let anyone tinker with your settings," I was warned. A tech unfamiliar with my history would assume that my settings had to be wrong!
[wry smile while shaking head] That's me.