What if your heart can’t sense paced beats?

I noticed from past print outs of my heart that whenever I A pace I V pace so my AP/VP is nearly 90%. My AS/VP is very low. I don't think my AV node senses APaced beats. Anyone know why? I have print outs of an AS beat with VS and the same heart rate range AP with VP and my heart could have easily beat the PM bc the pacer AV delay was long enough my heart could have beat it but it didn't. My heart just waited as if I didn't sense a AP beat. Why would this happen and is it fixable. My problem is when I'm at my LRL I have Issues bc of this. My AV delays are long and if an AP beat comes along I don't pace until the paced timer runs out which is 250ms. Makes me feel sick and lightheaded. Why won't my Av node acknowledge or respond to pace beats. I hope this didn't sound too confusing. I have an appt with my doctor in 2 weeks but I wanted to know ahead of time what it could be or at least be able to explain what is going on. Thanks. 

3 Comments

Sorry my Av delay is 280

by PacedNRunning - 2020-05-12 04:17:33

Sorry my AV delay is 280 not 250 in the examples I have. We did make my AV delay shorter and it did help but why pace me more because my heart can't see them? 

 

thanks 

Would need more information about your Mode and other Settings to make sense of this

by crustyg - 2020-05-12 18:35:28

There are a lot of safety features built into modern PMs to prevent over-pacing, over-sensing, PMT,  and, of course, to prevent the PM delivering a pacing output during the relative refractory period after depolarisation - this could lead to VFib.

When you say AV delay, what's the exact term in your Settings Report?  Are you quoting PVARP, or Blanking time?  Or something else?  What mode are you in? DDIR with RythmIQ?  What was the primary indication for a PM for you? CI? HB?

Parameters like Sensed AV delay are patient specific and depend on lead location, your conducting tissue performance.  Is your AV node intact?  Do you have effective retrograde AV conduction?

Perhaps I'm not reading your question well: a paced timer that runs out at 250ms before the PM will deliver a V-pace would give you a vent-rate of 240bpm.  Seems a little high - what's your LRL?  My Accolade will wait 1200ms before it triggers a pacing output if it hasn't sensed anything.

Perhaps we could share more details via a private message?

I will send you a PM thanks

by PacedNRunning - 2020-05-12 18:56:24

Check your box,

 

Thanks

 

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