Ventricular spikes

Just had an EP visit and was told that I was having a handful of ventricular spikes. 121 to be exact. Hardly a handful to me. When I asked why, The EP has no idea and said that some people just get worse after a PM implant. He then walked out of the room bc he has other patients to see. What am I do to with this information?  What does it mean?  
Also, upon implant my heart was paced at 67%, then it dropped to 47% and now it is paced at 27%. What does this change mean?  I am so confused. 


11 Comments

Spikes?

by AgentX86 - 2021-08-04 19:43:01

I have no idea what a "ventriculat spike" but perhaps he meant a "premature ventricular contraction" (PVC" that might look like an extrsneous spike (QRS) on an EKG, I guess.  If so, they're nothing at all to worry about. Everyone (everyone) has them.  127 in how long? In ten minutes? Yeah, something to be concerned about. In ten hours? Maybe something to watch. In ten days? Forget about it, particularly if you didn't notice them.  I found that magnesium got rid of them (my bloodwork has always been short on Mg) and my leg cramps as a bonus.

Your pacing percentage means about as close to nothing as nothing can get. Change the PM's base rate and the pacing percentage could go from 0% to 100% instantly.

The fact that he gave you (unimportant) "information" and didn't bother to tell you what it means is not good. Anything he says deserves an explanation. If it's not important, say so or shut up. If it's important, explain it! When I see my cardiologist, there is always time for small talk. If there's anything important he uses that time and/or extends the visit a little longer. There is never a rush.  My EP is a little more conservative with his time but it's never rushed. Find doctors who will educate you, rather than just hurl bombs over the wall.

 

Confused

by Persephone - 2021-08-04 19:50:56

I don't have any technical information or advice to offer, Rosenberger, but you deserve better information from your EP practice.  Do they provide a portal where you can access your reports/ test results online?  If so, maybe some sense could be made from those reports. Could you schedule a follow up appt where the doc can give you the full attention that you need?  I hope you're able to get some answers.  We're all taking this PM journey one step at a time.

Off topic

by Persephone - 2021-08-04 20:02:20

My EP retired this year and while I've always been a fan of just dealing with one's health care providers and accepting that the "chemistry" or however one wants to describe good communication is not always there, I have to admit it was challenging to meet my new EP.  Of course I will give this new relationship some time. The retired EP had similar relaxed traits to Agent's description, which I really appreciated and benefitted from.  Change can be hard.

Ventricular spikes and pacing percentages

by Dixie Chick 65 - 2021-08-04 21:40:29

I am not sure what the Ventricular spikes are but I can speak to your pacing percentages. It is common at the time of implant for your EP to set your amplitude a little higher -this is done to get your heart “ used “ to being paced. At implant mine was 3.5volts in atrial and ventricular leads. One month later it was reduced to 2.0 volts. Three months later at my next device check the atrial lead was again reduced. My EP told me that the pacing percentages change frequently. I’ve had my PM a little over a year and I’ve found that to be true. Be sure to ask for a copy of your “ Session Summary “when you go in for a device check. There’s lots of information on there. Lots of it you won’t understand unless you’ve had a cardiology Fellowship ! But you can use that to “ self educate “ and the more you can understand about your device, the better you can deal with it. And  I agree with AgentX86 and Persephone about your EP ! It’s not being unreasonable to ask for explanations !!

 

DC65

Pacing percentage and voltage

by ar_vin - 2021-08-04 22:03:58

There is NO connection between the "pacing percentage" and "voltage"!

Pacing percentage refers to the percentage of beats that the PM provides of the total beats in a given time period. As Agent pointed out earlier in this thread a higher setting for the base rate can lead to a higher pacing percentage. Simply lowering the base rate (if warranted) will lower the pacing percentage.

The OP did not raise the issue of voltage - NOT the topic of this thread.

Please refrain from muddying issues that end up further confusing members who ask questions to gain clarity.

 

121 ventricular spikes ?

by Gemita - 2021-08-04 22:39:38

I see you have received good advice so far.  I would hit back and ask your electrophysiologist/cardiologist:

What exactly do you mean by ventricular spikes?  Do you mean, for example, spikes in my heart rate as in “121 episodes of a non sustained tachycardia” affecting my ventricles?   Can you please define ventricular spikes?  

What are you to do with this information.  What does it mean?  Only your doctors can really answer this depending on what they actually saw on your paced ECG.  The only thing I can say is that I did have a worsening of all my arrhythmias following pacemaker implant initially, both atrial and ventricular in nature and I certainly felt an increase in my episodes of a higher heart rate which continued for approximately three months.

The pacing percentages may not mean that much or be significant since settings changes like changes in base rate can dramatically affect pacing percentages.  For instance I am paced almost 100% right upper chamber (atrium) but at a higher pacing rate of 70 bpm.  Reduce that rate to say 60 bpm and I would no doubt see a change in my atrial pacing percentages.  So percentages can be volatile.  More important is how we feel.  If we feel comfortable with our hearts, then chances are that the pacemaker settings are right for us.  I feel better being 100% paced in my right atrium and only minimally paced in my right ventricle.

An ECG of a Ventricular paced rhythm will show ventricular “pacemaker spikes”, but I am assuming your doctors are not talking about this when they say you had 121 ventricular spikes?  I would get your electrolytes checked if you have started having worsening arrhythmias or spikes in heart rate.

Thanks to all of you.

by Rosenberger5 - 2021-08-05 22:39:37

I appreciate all of your responses. You have no idea how comforting it is to read them, and then process how this applies to me. I get more out of you all then my doctor. I do have a portal to access, but he is vague. When I ask questions on the portal, he tells me to ask my other doctors, who have already told me to ask him. It is frustrating. So thank you all. 
 I think the ventricular spikes as he called them, are my pulse spiking quickly. I have had  121 since April 8. 
For example one of the spikes went to 189 bpm for 27 minutes long. I was digging a trench at the time this happened.  I felt a pounding at the time, but nothing that kept me from continuing. I have isolated when most of them are happening. I am usually hiking or doing something strenuous. I was hiking today and felt one hard pound in my back, while other times the pounding will last longer until my pulse goes down. I just don't know and I am certainly not getting answers or the time from my doctor. So again thank you all for helping me figure this out. Scary not knowing. 

Spikes

by AgentX86 - 2021-08-06 00:39:03

Ah, this s a lot more information. It sounds like SVT (non-specific atrial tachycardia). It has the signature of atrial flutter (AFL) but could be a number of things. What has your EP done about it? Drugs? It doesn't sound like he's too concernd but if my guesses are correct, it should be treated.

Have you ruled out structural heart disease? Blocked arteries can have this sort of effect too. Been there, got the merit badge.

Spikes

by Rosenberger5 - 2021-08-06 10:47:51

I am just in the beginning stages of trying to figure it out. I am working on getting my thyroid medicine regulated first and then pursuing this further. I am not sure why my Doctor  isn't concerned, but with me only having a pacer three months, I am still in the questioning phase and concerned about everything. 
Thank you for the suggestion. Thank you for caring enough to respond. I will certainly look into this.  

Thyroid

by AgentX86 - 2021-08-06 13:01:00

That may explain everything. As you probably know, the thyroid is the body's master organ, with feedback from the pituitary, and controls all else. Get that pair out of whack and anything can happen. When you get your thyriod on an even keel you may leave all yhis behind you. It's probably why your doctors aren't concerned but they should have let you in on the secret.

Thyroid

by Rosenberger5 - 2021-08-06 23:22:40

AgentX86 Thank you for your encouragement. I will keep everyone posted. 

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