Pacing a lot

So August 16 2021, I was pacing atrial 34.7%, ap-vp 0 and as-vp 0 

Then on August 2oth, I started having a weird pause feeling. That was my ventricle lead which is a his bundle lead, pacing and the delay was pretty long.  Had my settings changed with mvp shut off. That was August 31st. Interrogation from that day showed atrial pacing 78% ap-vp 0% as-vp .01%. So now I feel these beats that feel like pvcs. Check kardia ecg and have a wide qrs. Settings changed again so on Sept 7th Interrogation.  Atrial pacing 89% ap-vp 2% total vp 2%. 

After trying to change settings to get a narrow qrs, doctor said it is what it is basically.  I know 2% ap-vp is not a lot. But after 3 + years, I never had vp at all. Now I have ap-vp. What would cause the ap-vp percentage to increase? And is the doctor correct at saying my qrs will always be wide? What if I'm vp and my hr were to climb up to say 130 + is that going to be a problem? When I'm ap-vp the qrs is also wide. 

And as of now pacing ap 92% and ap-vp 5%  the ap-vp and just as-vp is causing chest pain. 


Pacing a lot

by AgentX86 - 2021-11-02 20:12:28

First, there is no magic number for pacing percentage.  It's almost an irrelevant number.  Changing PM settings, as you now know, can change the pacing percentages a lot. For instance, if you lower the pacing rate, AP will climb until it's 100%.  If the pacer is faster than the SI node, it's going to always win.  The same goes for VP.  If your pacemaker is set lower than the natural delay of the AV node, VP will always win.  So, the numbers, alone, mean nothing.

Your doctor should set your max Pulse rate to keep you safe.  By the "rule of thumb" ((120-age)*.9), your max should be 160ish but your EP is being very safe, for now.  He may increase it later.  A wide QRS is reason to be cautious.


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