ATS

The pacer techs are relunctant to tell me anything about check-ups other than expected battery life and I don't see doc until July to ask him. I do get an online report so I am seeking help on understanding it. 

There is a line called Atrial Tachy Statistic Percent Time in Mode Switch. On my remote check report from today it says 10%. Is this the amount of time I am in atrial fib? My underlying rhythm is sinus rhythm, second degree Type 1 block with an underlying rate of 30 bpm. My RA is 60% paced, RV 98% and LV is 99% today.  I know I have intermittant afib, and I am wondering if my time in afib is increasing. The last 2 previous checks said ATS % time was null%, but a year ago July it was 11%. 


5 Comments

Knowing what brand and type of device model etc would help

by asully - 2021-04-27 21:20:58

My device report sounds slightly different than yours it has an actual line that says percent of time in atrial fibrillation.  Although you also need to know the tracking numbers for the parameters.  For example my old devices were "supposed" to say and record any time I had SVT.  But the out of the box settings were not tracking or reporting them unless they were over 180bpm.  My SVT likely went undetected for some time due to this (it was in the 130-140bpm) range.  If you have a good EP they will adjust tracking parameters for you if you ask.  Anyways your report is different than mine so I can't answer your original question.

Edited to say: I do think that what that line means (and this is me just guessing) is the amount of time your device mode switched due to an atrial tachycardia event.  If you are atrial sensed V paced this can happen whenever you hit what people often refer to on here as their upper limit or upper rate limit (which also can be adjusted).  So for example my upper rate limit used to be set at 140bpm, this meant that my ventricals would match the atrial sensed rate up to 140 bpm.  If the atrial rate went over that amount the device would switch modes where it conducted to the ventricles at half the speed of the atria the is also known as pacemaker mediated weinkebach (and in my personal expierience is miserable lol).  It sounds like your report might be saying the time it switched modes like this, I could be wrong.  If you are having frequent mode switches and they make you symptomatic ask about the possibility of raising you upper limit.  Mine is now set to 175 I asked for 180 my EP suggested 170 so we split the difference lmao.

Hope this helps!

understanding settings

by Julros - 2021-04-28 00:48:55

This does help. My upper limit setting is 140. I don't know that my sinus node will go any faster,.When I do get a tech who is willing to tell me more than battery life, she said that my heart rate does not go faster than 140, despite of what my apple or garmin watch reads. The doctor is adamant that he will not increase the rate due to my age (64). He relunctantly raised the rate from 130, and I have had other settings adjusted twice to help with jogging and cycling. The cycling is still rough, but I plan to ask for further adjustment in July.

I have a Boston Scientific Valitude, CRT-P, DDDR, 60-130.

I think the answer to your Q is 'Yes'

by crustyg - 2021-04-28 03:57:52

If you're fitted with CRT-P, then I can understand why the EP-techs are being strictly professional and leaving all of the discussions about your heart, progression/improvement, prognosis to your EP-doc.  And your profession makes some of them nervous - I know that some of the less experienced/confident EP-techs that I see stick rigidly to protocol.  I try not to put them under more pressure by asking them for things that I am fairly sure they will have to deny or refer about.

If your ATS percent is increasing as you say, then yes, your AFib is becoming more common.  Your data suggest that your SA-node is also failing, perhaps due to the same process that's pushing you into AFib.  Normal sinus rhythm with your HB shouldn't need 60% RA pacing: that's the evidence. Before anyone shouts at me, that ATS doesn't necessarily mean AFib (and that's correct), you've already said you have intermittent AFib, so that's almost certainly what it is.  But there are other atrial tachys.

Start writing down questions for your EP-doc consultation in July.

Atrial Tachy Statistic % time in Mode Switch

by Gemita - 2021-04-28 06:04:56

Julros,

I suffer from in and out (frequent) AFib/atrial tachyarrhythmia episodes and my mode switch is unfortunately in operation a lot of the time.  They usually give me the number of mode switches (counts) that have occurred.  This is separate from the percentage time I am in AFib although mode switch counts is often used in conjunction with % time I am in AFib to work out whether my AFib is increasing.   

Although my mode switching is happening several thousand times over a period of say six to 12 months, my percentage time actually spent in AFib is still quite low - 8% on average - (and it has stayed at this level for years), but it is the often frequent, short, in and out bursts of Afib and frequency of mode switching which can be so destabilising.

Your question specifically asks whether the ATS % time of 10% is the time you are in AFib?  Not necessarily. The 10% figure no doubt also includes other atrial tachyarrhythmias like any Flutter, SVT, AT, ST for example that you might be getting although my EP generally lumps all my atrial tachyarrhythmias “together” when I ask for further info.  

The 10% figure would exclude atrial tachyarrhythmias which do not meet the parameters set up in the pacemaker to include it in the ATS % time figure.  Ideally you need to know at what speed and duration your pacemaker is set up to record an atrial tachyarrhythmia event which will activate your ATS %  and the percentage time you are actually in AFib, Flutter, SVT and so on.  These should be separate figures.   For example you could be going in and out of AFib at lower speeds, sometimes for a very short duration which might not show up in the ATS % figure, so a total % figure in AFib is a more accurate way of confirming your actual % time spent in AFib.  Yes you need answers Julros, but you are doing better than I am in getting information it seems.

Is your AFib increasing?  AFib can increase during one period of monitoring and then completely disappear or reduce over the next period, that is the nature of the beast.  It can be so variable and as an experienced Afibber I would not read too much into any one set of figures.  Only time can really answer that question and any worsening symptoms.

It has been a lot of work Julros but I have kept a diary of any major symptomatic events (longer episodes atrial tachyarrhythmias) since 2016 (before my pacemaker in 2018).  I have noticed that post pacemaker my significant episodes have diminished in intensity, duration, frequency, so much so that I have been able to reduce meds and put an ablation on hold.  I know immediately I go into any significant AFib/other atrial tachyarrhythmia event and this is always confirmed by my pacemaker clinic when they ring me or I attend for a check.  A significant Multi Focal Atrial Tachycardia event which I recorded in my diary was seen/confirmed at my last check so a complex picture to add to my Flutter, AFib, SVT, but even so, my pacemaker is helping to restore order at a steady 70 bpm and I am getting some real relief at last. 

Good luck Julros and I hope your pacemaker helps you too

follow up

by Julros - 2021-04-28 15:56:01

I contacted the clinic about A fib episodes and the tech was able to give me a verbal report about my A fib, but is not able to send me a written copy. Even though I explained that I have gotten this in the past and I use it to correlate with my activities she said it wasn't allowed. I asked who else I could speak to so that I can get this: her supervisor, practice manager or doc. She wasn't sure, and then explained how short handed they were. But I did get a call from their medical records who offered to send me the info, once I submit a request for records. So I will send them a release (will have to do this each and every time) as well as a copy of the a fib events report I recieved last summer. And someone is going to call me about scheduling an interrogation with exercise. 

And I am compiling a long list of questions for doc. 

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