Check ups

Doesn't quite add up

by crustyg - 2021-02-19 18:02:41

It's not necessary to deprive any patient of their pacing support for more than 3-5 seconds during a PM change, so it should be exactly the same as when they tell you they are going to stop pacing you in the clinic - to establish whether you have any 'escape' rhythm and if so, what rate you can manage.

If they couldn't manage a rapid swap over from one box to another then they are not properly organised, and most cardiac suites will have an emergency pacing box available in case of someone dropping the new PM and rendering it useless to go inside you.  Old PM=>standby box is 3-5 seconds, standby box => new PM another 3-5 seconds.

On the other hand, if you're lying flat then you don't need much of an output from your heart to achieve enough BP to keep your brain adequately supplied, and, in general, any rate from 20-25BPM will do, for a very short while under these circumstances. 

My guess - and it's only a guess - is that being told you weren't going to be paced for several minutes may have triggered a panic attack - and that increases the need for cardiac output at exactly the time your heart's pumping of blood was sharply reduced (no PM), and that's why you felt so terrible.

Question is, do you feel OK now that you have the new PM?

Natural physiological ventricular activation

by Terry - 2021-02-19 18:10:48

Turning the pacemaker rate down can promote natural ventricular activation via the His-Purkinje system for lower risk of "pacing induced cardiomyopathy." The only pacing method for normal ventricular activation is to have the lead moved to the His bundle for His bundle pacing (Google that). All the best to you.

Terry

His

by AgentX86 - 2021-02-19 23:34:32

Terry, do you ever think about anything else?  This has nothing to do with the pacing strategy.

His

by Terry - 2021-02-20 02:14:23

I don't want this to be about me, but I plan to spend rest of my life empowering patients, and those who love them, with the facts. Please join us in pormoting the exponentially rising practice of paced patient morbidity reduction through physiological ventricular activation. What my doctor calls "pacing induced cardiomyopathy" is unsustainable. Observation: In the end, patients always, always win. Blessings,

Terry 

Thankyou

by NicoleG - 2021-02-20 06:26:53

Hi yes I feel absolutely fine and to be honest my new pacemaker seems to be pacing better than the old one. I definitely had anxiety wave over me hence the sedation helped I suppose like you said they drop my pm and my heart kicked it if I hadn't have panicked maybe I could have tolerated it more.

Thanks for your replies 🙂

His

by AgentX86 - 2021-02-20 14:22:44

So you're going to spend the rest of your life being a one-trick pony, even when no one is even talking about anything to do with your one trick?  You're doing a fine job!  Meanwhile, you have no credibility for even that one trick.

Panic

by AgentX86 - 2021-02-20 14:27:36

Yeah, I'd probably panic if they told me they were going to screw around disconnecting my PM for five or ten minutes.  I'd be four or nine minutes dead by the time they were done playing.  That sort of talk does tend to irritate me. ;-)

Very good

by hannahberry - 2021-02-25 03:23:22

The blog is very nice!