From Ariela again: pacemaker settings

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

3 Comments

Stay Positive

by LeeT - 2013-02-18 05:02:42

I suggest you follow your doctors conclusions and ask questions but try not to be abrasive, doctors have many patients they will be more responsive to you if you think of them doing their best for your recovery. Where you you be today with out their care??

Complicated issues

by donr - 2013-02-19 02:02:01

Ariela: I sent you a Pvt Msg. It should be there right now.

Going anywhere in this weather & this time of year in your part of the country is a hazardous journey. After all, the only thing between Cedar Rapids & the North Pole is three strands of barbed wire & ten gadzillion mosquitoes in Minnesota.

Don

Pacemaker mediated tachycardia

by golden_snitch - 2013-02-19 04:02:57

Ariela, what you are experiencing is so-called "pacemaker-mediated tachycardia" (PMT). With everything your doctor is doing, he is trying to stop this tachycardia from happening. It's not so easy, because apparently you have a retrograde VA-conduction which means that the impulse coming from the atria can not only travel down to the ventricles, but your AV-node also allows signals from the ventricles to travel backwards into the atria. This is how you get a reentry-circuit and tachycardia. This retrograde conduction makes it a bit difficult to program the pacemaker.

I have had this problem, too. And my cardio has told me about another patient in whom he really has problems to program the pacer in a way that it doesn't go into pacemaker tachycardia. What worked for me - before I had my AV-node and this retrograde conduction ablated - was to suppress the retrograde conduction with drugs. There are anti-arrhythmic drugs out there that slow down the AV-node, and this can also have an effect on the retrograde conduction. I tried betablockers, Verapamil, Flecainide, Propafenone, Amiodarone, Dronedarone, Sotalol for years, before we decided to ablate the AV-node.

It is nothing serious, but as you said it makes you feel awful and therefore it should be treated.

There is a good article about pacemaker mediated tachycardia at:
http://emedicine.medscape.com/article/159645-overview

Inga

You know you're wired when...

Muggers want your ICD, not your wallet.

Member Quotes

I wouldn't be alive if it wasn't for pacemakers. I've had mine for 35+ years. I was fainting all of the time and had flat-lined also. I feel very blessed to live in this time of technology.