New Settings

Had 3 month post-implant checkup last week.  Chronic settings set and floor set at 60bpm.  Cardiologist said that the interrogation report showed some Afib and LOTS or rapid bursts of Atrial activity.  Recommended I see my EP.  Saw EP today and he did another interrogation and there were a bunch more of those short bursts of atrial activity.  He said "we're going to break the elephant down into manageable pieces" and decided to raise my floor to 70bpm and turned on Rate Response and Minute Ventilation.  I had told him that I have had absolutely no energy since implant.  The changes today he said were to start helping me feel better.  He said that sometimes upping the low setting up from 60 will reduce the short bursts of atrial activity that could be triggered from the lower rate.  He did a decent job explaining Rate Response and MV and said that there is usually some tweaking needed on those features to dial in the best settings for my situation.  The interrogation showed that since last week my heart rate has not gotten over 71bpm (other than the short bursts) and that was the main reason for cutting Rate Response and MV on.  Said he wants to see a bigger spread of heart rate ranges.

it does feel a little weird.  Prior to implanting the PM my normal heart rate was in the low to mid-50's.  After implant the HR stayed pretty dang close to 60bpm.  Not used to 70bpm resting.....   LOL

I have also noticed that it doesn't take too much activity to feel my HR increase now with the new settings.  Will take some getting used to.  Go back to EP in 3 weeks for a checkup.  Will tweak settings if needed and if the rapid bursts are still occurring he said we will tackle changing my meds up.....



Afib + Atach

by AgentX86 - 2021-05-18 23:52:55

It sounds like your EP is doing everything he can do.  Sure, it feels weird having a fast heartbeat.  Mine was in the low 40s at night.  After my AV ablation and PM, my EP cranked it op to 80bpm.  You bet that felt different.  I complained until he told me that there was a higher chance of SCD after an AV ablation but that starting at a higher rate solved the issue.  A month later he dropped it to 70bpm, then planned to set it back to 60bpm after another month.  At 70bpm I started having a runs of bigeminy PVCs, so went back to 80bpm, which is where I am still.  He did drop it to 50 at night so that I could sleep. I've gotten used to it so the faster rate doesn't bother my anymore.

So, the short story is that raising the speed can out-pace some arrhythmias.  Yes, Rate Repsonse can take some time to get dialed in right.  It sounds like it may be set a little too agressively but you're probably just not used to be burst of energy.  If it's set way too high it can cause feelings similar to what it feels like if it's too slow.  It takes some balancing.  Everyone is different and the range of activity is very large.  It's easy to set up a PM for couch potatoes.  It can be really hard to get RR working right for someone who is very active, particularly if it's doing different activities.  There will likely have to be some compromises made.

It's also very good that you have an EP.  Everyone with a PM should be seeing an EP for it rather than a cardiologist.  If there are other physical hearth issues, both may be in order (I have both).  Cardiologists are plumbers.  EPs are electricians.  You don't call a plumber when your lights go out.

In short, you seem to be in good hands.


Thanks AgentX

by Laidback1 - 2021-05-19 18:51:45

Thanks.  Makes me feel better to hear that.  Yes, I like my EP and he is well respected in the San Antonio area.  I'm a rancher so all my "activity" is working out on the ranch.  Hopefully he will be able to dial in the settings to my lifestyle.  

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