How common is this situation in your experience?

Great results John

by Gemita - 2022-01-21 11:17:24

John, hello, 

It sounds good news.  I suppose the all important question is how do you feel with your base rate set at 40 bpm and being in VVI mode?  Your EP’s experiment has certainly worked to reduce your % ventricular pacing.   

Are you able to comfortably carry out all your activities during the day and any extras like running, cycling?  If you are feeling okay, then it would appear that your heart is coping very well without pacemaker support.  Perhaps at the time of your pacemaker implant you had an “acute illness” which is now being  effectively treated, resulting in an overall improvement of your AV Block.  However it does seem to me that your reduced % pacing is also likely to be as a result of your lower Base Rate setting of 40 bpm?  Hopefully this indicates that your own heart is well above this minimum setting at all times and more than able to cope with your lifestyle.

Like you, since my pacemaker implant I have experienced an improvement in my electrical disturbances which I think is fairly rare since most of us perhaps would expect a slow progression of our symptoms, requiring ever increasing pacing support.  However unlike you, my base rate is set much higher (at 70 bpm), so although I need only minimal ventricular support for intermittent right and left bundle branch blocks, because of my high base rate, I am almost 100 % atrial paced for maximum benefit.

Even though you are only 1.8% ventricular paced, your pacemaker is still needed, since it only takes seconds to lose consciousness and to have or cause an accident, but it is great news John and I would be very happy with the results.  I hope too your joint pain is being effectively treated and that despite your immune suppressant medication, you stay safe and well

Good to hear from you!

by quikjraw - 2022-01-21 12:07:08

Hi Therese,

I have sent you a message in the message section by the way!

So because VVI40 ignores the atrial lead my actual base heart rate (SA node) is not relevant if that makes sense? 

I think if my block does not literally disappear then I will push for a higher supporting ventricular rate. At the moment by my calculation for this setting is it will wait a whole 1.5 seconds between Ventricular beats before pacing.  That seems too long and means if my block is still present to any degree I will be missing beats.

I wonder now if we could still keep the pacing low if I asked for DDD pacing but with a wait of the maximum 500ms after an atrial beat. That way I would never drop a beat (the point of the pacemaker) and may still have low pacing values?

Something I will put to them after a few more weeks on the bike I think.

I do feel what I can describe as palpatations when sat resting in the evening and I did not feel this before the new settings. I am assuming this is the fact there are long pauses sometimes and then a big kick of a beat from the pacemaker?

VVI

by AgentX86 - 2022-01-21 14:54:22

I don't understand VVI mode at all.  As you say, DDD seems a lot better in your situation but we're not EPs either. VVI would put you into AV dyssynchrony, which may be the cause of the palpatations you're feeling (in and out of VV mode).

You're right, your atrial lead is totally ignored in VVI mode.  You get no pacing or sensing in that lead.  As I noted above, that would necessarily cause dyssynchrony, which isn't usually the desired outcome.

The 40bpm rate has to be a floor under the floor.  That is, you're not intended to ever go there.  It might be the suspenders on top of the belt. Raising this rate wouldn't do anything good, I don't think and may hurt.  It seems to be an area where you don't want to be. Raising it may make that area larger.

Possibly atrial sense -> ventricular detect too short?

by OscarAli - 2022-01-31 00:37:25

I'm a long time athlete and my AV block is primarily at low hear rates 60s and below. It started as 2:1 block with an effective rate in the 30s and I was totally asymptomatic and it only happened at night. When they threw in a pacemaker (Micra AV) they did mininal setup (which is why I use the word "threw", it was like they felt they'd done their job once it was in).

The wait between atrial sensing to vetricular pacing set was too small so it wasn't waiting long enough to see if there was natural conduction and so it was competing with my natural rhythem. In the end I had to dig out a programming manual and tell them what to change. They reduced it and that helped. I wonder if that's what you saw?

Since the procedure, and their totally screwing up the programming, I've spend time learning to read ECGs, I have a Kardia Mobile device and from that I can tell if its pacing or if I have natural condition. It's also helpful for me to measure the PR intervals to see what going on.

Note for AgentX86. VVI mode is useful for people without complete heart block. VVI40 just means that if a ventricular pulse is not detected within 60/40 seconds it throws one in. 40 bpm can be just fine for many people. I was perfectly OK with 35 and I have a friend with a resting HR of 30. Everyone is different - in fact I'm tempted to tell my EP to set mine to VVI30 - and before you get all weird on my like you did with erichlin, yes, my EP did mention that as a possibility.