New To Me Boston Sci. Pacemaker

Hello,

Just now getting on with my recovery after recent implant. I was told initally the only time I will hear from the PM is when my pulse drops bellow set threashold. I have SSS with Syncope last past two years due to LBB. Finally the Dr. was able to see what was going on with a Bio-Tel Remote monitoring. Anyway that is the background. When I started to have symptoms Post Surgery of heart palpitations, hard to breath etc. The Dr. was not sure, maybe tacycardia but I said I was going to get an Apple Watch with ECG documentation. Once I caught these episodes, the ECG came back with AFIB. I showed the Dr. the ECG recordings and said "Oh that is the Pacemaker firing off" I said "but you said the PM will only work during low Pulse". The times when the PM went off my pulse was above set threshold. The Dr. Said Oh, your PM will also work based on Respitory Response. My Dr. Is not very forthcoming on settings or when PM will be expected to work. Any feedback from you all would be apprectiated. I was looking for settings and PM opeation. I am a technician and like to know how things work. Thanks


3 Comments

Pacemaker "firing off"

by AgentX86 - 2021-05-01 14:12:55

A lot depends on the precise nature of your problem.  You said that you have SSS, which makes some since with "only time I will hear from the PM".   Then he's telling you that it's pacing "based on Respitory Response".  This indicates that he has "rate response" turned on, which implies that in addition to SSS you have CI (chronotropic incompetence - heart rate doesn't modulate with oxygen demand).  CI very often follows SSS since both base and demand rates are controlled by the sinus node. 

With rate response turned on, it's not only pacing when your heart drops too low but when the pacemaker thinks you need more oxygen.  Pacemakers can't tell what you pO2 level is so have to guess.  Most use an accelerometer to measure motion as a proxy for oxygen demand.  Yours measures your breathing rate,  Both are only approximations and work well within some bounds.

If you don't have CI, you probably shouldn't have rate response turned on,  That will confuse things.

The bottom line is that your doctor hasn't told you the whole story.  I'd get a copy of your pacing report and sit down with it and the manufacturer's web site and fiure out all your settings and what they mean.  This will make you well prepared to ask questions and get real answers.

Pacemaker tech

by Theknotguy - 2021-05-01 20:10:52

It may be hard to do during this covid situation, but if you can get into a hospital and chase down a pacemaker tech, you can get a lot of information from them.  However, you'll need to come prepared.   They aren't allowed to "practice" medicine so your questions have to be based upon tech issues.  Having  said that, they are a wealth of information since they have to support quite a few versions of the pacemakers.  They can answer questions sometimes in more detail than the doctors as they have to know how the pacemaker will perform.  

At five years out I ran into problems where I couldn't walk 1000 feet without running out of air.  I'd have to stop and gasp for air, then would be OK for the next 1000 feet.  They adjusted rate response, but brought in a tech for the final adjustments.  He brought up screens on the monitor I hadn't seen in the previous five  years of having my pacemaker.  I still can't tell you what he said as most of it came out as gibberish.  He said something like - I'll adjust the green gazorp with the blue whingy-doodle if that's Ok with you?  I said "OK,  sounds good." And he said, "Great! I've already done it."  After that I started feeling a lot better and could walk the 1000 feet without gasping for air.  I wasn't able to ask the tech too much as he had to go back to the hospital and wasn't able to connect with him at the hospital but he sure knew what he was doing and knew a lot about  pacemakers.

Don't know if you can make it into the hospital and chase down a tech, but it's something to keep in mind.  
 

Device tech

by AgentX86 - 2021-05-01 22:26:33

A device tech isn't going to be able to do much without at least an EP/cardiologist signing off on the changes.  I've found it pretty easy to work with device techs but they'll only do so much without direction and every little thing gets forwarded to an EP for review (I see it on my statement ;)

Covid shouldn't be a probem anymore, though some states are still in crazy-land.  AZ (and OH, for that matter) are in pretty good shape now (~10 cases per 100K).  MI is really bad now but the rest of the US seems to be settling down fairly well. 

 

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