Recent remote transmission question

So I'm 3 1/2 years in with my CRT-P, and post atrial flutter ablation. It appears that I am in atrial flutter for the majority of the time, which is why I am on Eliquis.

The report says "Episodes of AF/AFL shows occaisional undersensing with periods of pacing near max track. Review of presenting rhythm suggests RV paced beat comes before LV impulse. BIV pacing programed 0 offset. "

And then later on, the recommendation is to consider VVIR programing. 

So my questions are:

If up until now, my sensing and pacing checks were okay, what changed? Could it be progression of underlying disease? When the pacer rep took the necessary steps for my MRI last month, could she have changed something? 

Will VVIR save battery life? It looks like I lost a year of battery since my last check 3 months ago. And believe me, I'm in no hurry to replace! 

The earliest appointment available is on 1 month, but I am looking to arm myself with info. 

3 Comments

Could settings have been changed?

by Gotrhythm - 2022-04-01 16:04:31

Based on my experience, yes.

I have been told by my EPs techs that my pacemaker settings are so unusual as to apear unbeleivable to the uninitiateld.

To undergo hyatal hernia surgery, the pacemaker had to be put in 'safe' mode. I was promised the settings would be restored post-surgery. 

But after recovering from the surgery, I couldn't seem to get my energy back, even though the surgery was a success and I was completely healed.

At my insistance the pacer settings were checked at my EP's office, and it was discovered that they had been changed along several parameters to something the tech probably thought more appropriate for a delicate-looking, near 80 years old woman.

Once settings were restored, I was able to function normally (my normal) again.

I have no opinion of the utility of changing your pacemaker mode to VVIR. But if you wonder if your settings could have been changed, it may be worth your while to check it out.

Interesting problem

by AgentX86 - 2022-04-01 18:06:23

Do you know what pacing mode your PM is set to now? I've been thinking of various scenereos but without some real wierdness (e.g. errant A/V pathways) it's hard to see how this happens.

It's possible, but very unlikely, that your PM settings were changed during an MRI.  The PM tech copies your settings to his programmer before the MRI, places the device in a safe mode, then copies those same settings back after the MRI.  There is no reason to even look at them. He's not going to report them back to your EP.  That's not what he's tere for. Of course, blunders happen.

No VVI mode won't change the battery life and even if it did, even a large difference would be irrelevant. If it's needed...

Battery life estimates are just that.  Very crude estimates at that.  Just by monitoring the voltage on a battery, it's next to impossible to tell how much gas is left in the tank in the middle of its life.  More towards the end, it becomes easier.  Fortunately, this is when it's important.

 

Thanks for your comments

by Julros - 2022-04-02 05:48:40

My previous settings were DDDR, rates 60-155. After my ablation I was told my underlying rhythm was snus rhythm with  a slow Wenkebach with a rate of about 30 beats per minute. Now my atrial rate is about 270 beats per minute, and my low rate is 70. 

I thought the pacer rep would just restore my previous settings, but I started to wonder when she said "If you feel anything funny, it's just me." I thought they only said that when they were checking for capture, by decreasing the output. This is the same pacer rep that took an hour to do my sister's first check after her implant and I was wondering then if she knew what she was doing. 

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