From Ariela again: pacemaker settings

• by Ariela
• 2013-02-18 04:02:13
• Checkups & Settings
• 1523 views
• 3 comments

First of all, please let me thank you for all the information you gave me. I am studying carefully, and I hope to understand better what is happening to me. Here is my background:
I am 74 years old, and I take care of my 81 years old husband – the love of my life. We have been married for 50 plus years. I have lost both parents and my only brother to heart disease. I have been diagnosed with SLE (systemic lupus erythematosus) for about 15 years. I have it under control. I was diagnosed with third degree heart block in 2004, and I received then my pacemaker. About 2 months ago I was helping my husband to the bathroom, feeling sick, light headed, nausea, cold perspiration, etc., when all darkened around me and I passed out. I was taken to the emergency room, and the attending physician said I was pacing 100% of the time. I don’t remember much, but I was given IV fluids and I felt better. I came back home. Later, I made an appointment with my pacemaker doctor, and this is what he wrote.
“A couple of days ago I read her emergency room visit EKG. This EKG demonstrated a pacemaker reentry rhythm. She presents today for evaluation. On initial device interrogation, she was in her pacemaker reentry rhythm at a rate of about 100 beats per minute overall. Manual PRVP extension was performed, which promptly terminated the tachycardia. Atrial pacing with Wenckebach then occurred. After the beep did not conduct, she paces in the ventricle and PMT reinitiates. The measured VA conduction time is close to 400 ms. First, we tried a programmed PRVP of 500 ms. This failed to produce a persistent desired response. This was due to rate-responsive PRVP being turned on. We turned off the rate-responsive PRVP. Still, during atrial pacing, she would Wenckeback. She would then pace in the ventricle with retrograde conduction to the atrium. This would set off a few beats of pacemaker reentry. This then terminated to a couple beats of sinus rhythm and a normal cycle repeated itself. This was felt to be an unsatisfactory resolution. Finally, the decision was made to program her with more physiologic AV delays and a permanently prolonged PRVP. In the end her final program settings are DDR with a paced AV interval of 180 ms. A sensed AV interval of 150 ms. PRVP of 500 ms. The upper tracking rate was lowered to 120 beats per minute as was the upper sensory. Rate responsive PRVP was turned off.
The remainder of the device interrogation demonstrates 1.9% atrial pacing and 36% ventricular pacing. P waves were 2.6 mV, R waves were 5.7 mV, atrial impedance 350 ohms, and RV impedance was 600 ohms. Programming changes as noted above.”
My concern is: Is my situation serious? Is this something that I need to look into or can I just let it go although I feel miserable at times? Do you think this doctor knows what he is doing? (He seemed frustrated with my heart, waved his hands and said: “I’m bypassing your heart.” Well, whatever that means! Should I go to Mayo Clinic? We live far from it, it will be quite difficult to manage with my husband, but if it is needed I will do it. Please, let me know your opinion! I’m so sorry for this long post but I don’t know how to shorten it! I am so grateful to you! Life is good: I have a computer, I have this site, and I can send you a post!
Ariela