rate change

Can some one explain this? 

She is very sensitive to rate changes with pacing so the device was reprogrammed. His notes included

Review of the datalog demonstrates 22% atrial pacing and 99% RV pacing with no arrhythmic events. The device was reprogrammed to make response times quicker with activity. 

This is a patient with a long history of vasovagal syncope who has now developed heart block. She is very sensitive to rate changes with pacing so the device was reprogrammed.  Thanks for all replies.  


2 Comments

What does it all mean ?

by Gemita - 2021-06-09 19:50:00

Hello Ms Rutledge,

I am assuming you have had a follow up appointment following reprogramming of your settings.  It looks as though several settings have been reprogrammed, particularly Rate Response, but also AV delay and PVAB, the latter two settings to prevent inappropriate mode switching.  Did they ever confirm chronotropic incompetence?  

Your post and the comments from your doctors seem fairly self explanatory, but I will let you have my observations as follows:

She is very sensitive to rate changes with pacing so the device was reprogrammed = I would interpret this as, they have made some fundamental changes to many of your settings because you are extremely sensitive to pacing (in right ventricle?) and to any sudden heart rate changes due either for example to:

. mode switching as a result of inappropriate sensing on atrial lead, or 

. to any settings that have been programmed, or 

. to any episodes of arrhythmia, triggering appropriate mode switching or other control mechanisms which cause you unwanted symptoms

Review of the datalog demonstrates 22% atrial pacing and 99% RV pacing with no arrhythmic events. The device was reprogrammed to make response times quicker with activity = your block would appear to have progressed and you are now almost totally dependent on your pacemaker at 99% right ventricular paced.  I note you have SSS (sick sinus syndrome) also and 22% of the time you needed pacing support in your right atrium, although it does mean that your own pacemaker (the sinoatrial node) was able to work without support for 78% of the time.  I am uncertain of the period this covered (presume three months) and these percent figures are not fixed and can change over time.

I am reassured that during the period of monitoring you had no arrhythmia events detected.  Excellent news.

Clearly Rate Response has been adjusted to make response times quicker with activity, so you should notice this immediately but the settings may need lots of fine tuning to get them just right for you.

Apart from the above, I really am guessing what settings they have changed.  I suggest as well as asking us for an opinion, you need to ask your doctors which settings they have adjusted, your mode of pacing (if changed) and if possible get a copy of all changes for your own records.  If you respond well to these changes, then all your struggles will have been worthwhile.  How do you feel now?  Is there some improvement.  I do hope so.  I am also very sensitive to ventricular pacing and I know many others are too.  Good luck

Rate change

by Ms Rutledge - 2021-06-09 21:06:23

Thank you Gemita, the reason for the  post,  was because during my visit with the Dr.  he only mentioned changing the activity  sensitivity, and reducing my high rate from 162 to 155 as he felt that 162 was inappropriate for my age, he did not address if I truly  have chrontropic incompetence.   He said to set up my next appointment in one year.  Before I got home his office called and stated I would need to be seen in 6 months for an in person interrogation.  I read his summary that he sent my primary care physician and saw the additional notes..   I hopefully will not see the  EP for a year, and felt confident some of the members could explain the sensitivity to pacing so I will have a understanding of exactly what that meant. I am keeping my fingers crossed that these changes will be the last.   As I have been trying for almost 2 years to get my settings correct for me.    Thanks again for you explanation.   

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