Possible replacement of PM with ICD


I've had a PM, for second degree heart block, since October 2018 with no issues.  Last week my cardiologist's secretary phoned and said the cardiologist wants to see me - This appointment is tomorrow.

It seems my PM picked up an episode of ventricular tachycardia [VT].  I don't know how long the episode lasted or if there was more than one.  I was unaware of any episode. 

My general practictioner advised me that the cardiologist most likely will discuss replacing the PM with an ICD.

I'm 75 and also have extensive coronary artery disease.

Am I correct in thinking that an ICD is the most efective way to mange VT and better than, for example, medication alone?

Has anyone here been in my position or would anyone care to comment?  

With thanks



Yes you are correct

by Gemita - 2021-03-30 04:37:41

Rick, because of your history of extensive Coronary Artery disease they will need to keep a close eye on you and if you have started getting episodes of VT they will want to control these to prevent them from progressing.  

The best way to do this is with an ICD, together with medication.  The ICD will restore a normal heart rhythm quickly and effectively.  Medication alone would not be as effective as an ICD in protecting you from the potential harm of a sustained VT episode.  

Tomorrow your cardiologist will explain what he saw.  Usually a non sustained episode of VT in a healthy individual would not be a cause for concern, but with extensive heart disease they will need to watch any VT closely.  Tomorrow please ask your doctor exactly what he saw:

Sustained VT (ventricular tachycardia) is defined as 3 or more heartbeats in a row of more than 100 bpm lasting for more than 30 seconds, which can become life threatening - hence the need for an ICD.  A VT episode under 30 seconds is known as non sustained VT which is less serious.  I get non sustained VT episodes but I do not have extensive coronary heart disease, only electrical difficulties.

I hope your appointment tomorrow is helpful and that you can be reassured that if an ICD is indeed needed, it may only be needed as a safeguard to protect you in the event of a sustained VT episode.  I wish you well.  Please let us know how the appointment goes

Thank you Gemita

by Rick1945 - 2021-04-06 03:14:07

Apologies for the delay in replying - I only just saw your comments. 

I am advised that I have had 2 or 3 non-sustained episodes of VT - lasting between 3 and 5 seconds over the past 10 months. I did not notice these episodes at all.

The cardiologist prescribed a very low dose of beta blocker and asked me to monitor my pulse rate.  My PM is designed to kick in when my pulse gets down to 50 and I think thie is happening now.  Only an hour ago I requested an interrogation from Boston Scientific and I received the report just a short time ago, amd am now waiting from a call from them to explain it.

The only alerts from the PM were for these NSVTs.  There are recordings of ATR and PMT events but these do not seem to trigger alerts. 

ICD doen't "manage" vt's

by BOBTHOM - 2021-07-25 23:25:53

Just an FYI, an basic ICD doesn't exactly "manage" vt's. If it detects an episode it will shock the crap out of you, basically stopping your heart so that it will restart on it's own in (hopefully) a normal rythm.  There is a portion where it will try to "pace" you out of it if it can by matching or increasing your heart rate and then slowly bringing it back down, but, that's more for vfib then for vtach.  In any event, the medication is what will do the most good with Amiodarone being the major antiarythmic. A bacic ICD is more of a fail safe so you don't die from the vtach or vfib, but cerainly not to manage it or improve your condition in any way.  Now they do offer PM's with ICD's built in, perhaps that's what they are plannig for you and that's a whole nother discussion.  Just sharing my first hand knowledge and perspective, not looking for an argument or debate as I'm sure there are some who will disagree.  I am not a doctor, do your own research, learn as much as you can so you can be prepared to make educated decisions!

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