update 1-A on high rate episodes

On Dec 5th recieved an email telling me that via the patient portal for the Heart Specailist i have a new message.  Looked an sure enough there was one from the Medical Records division.  They had finally responded to my email of Nov 2,2022. Saying there have been 2 recent tranmissions of 9/20/22 and Nov 27,2022 .She had printed out the summary and arrththmia log events for each transmission. Would leave them up front in an envelope in the records cabinet.  And i can pick them up and if i have any questions contact either the Cardio or EP doctors.

I had already picked up the Sept 20th  on Oct 6 by calling an leaving a message. Since i never heard back via the email method.

This morning looked at the  transmission Date -Nov  27 and Time 18:41:55.(either 5 or 6pm) which is not a time that i would be near the device which is on the nitestand next to my bed.  (this morning sent via the portal my question about the above).

Also the day that i thought i had a fast heart beat is not one of the days mentioned.

 In the box above the summary for "recent arrhythmias.". .  Atrial high Rate Episodes not  reported.-but in the summary below  54 were detected.

The unsigned Summary for this  one is "54 atrial high rate episodes dectected. ( All but 2 of these above were at rest). (. not every day) The longest lasted 00;1:15:04 in duration.  there was a 0.6% cumulative atrial arrthythmia burden. ns VT's dectected on 10,22 at 13:09 one lasting a second and the other 4 seconds.   EGMs shows runs of nsVT and PVCs (which the above is the only one shown in the report).  Difficulty to discern which beats maybe be sinus.  Duration 22 seconds with an avg  V rate 179bpm.   this next sentence is interesting as it does not match the concerns of the Cardio.   HEALTH TRENDS DO NOT DEMONSTRATE SIGNIFICANT ABNORMALITY.  i will continue with remote follow-up.

This above does concern me .  If i do not hear back will defintely bring this up at my appt on the 14th, with the cardio's PA . 

new to pace

7 Comments

Atrial high heart rate episodes

by Gemita - 2022-12-08 14:07:51

New to Pace, thank you for the update.  I must say, perhaps like you, I find the results somewhat puzzling particularly since you have been asked to attend a cardiac PET Scan which is an indication that they are concerned and need further information . . . and yet your results suggest no significant abnormality has been detected?  

Looking at your results, however, you are clearly having frequent, mostly short episodes of atrial tachyarrhythmias with some non sustained VT episodes too, the latter episodes lasting for one second and four seconds respectively.  Clearly New to Pace 0.6% cumulative atrial arrhythmia burden in a short period and 54 atrial high rate episodes detected might indicate that your AF is progressing which would be a concern particularly since you are not taking any medication to control the fast Ventricular rates when they occur or anticoagulants to protect you from an AF related stroke.

I have to say opinions vary between clinicians as to what is a serious finding depending on the patient and their other health/heart conditions.  A patient in heart failure for example would certainly not be able to tolerate a fast ventricular rate for even brief periods as well as a patient without heart failure.  Like me you are probably able to tolerate short episodes of high heart rates as long as they remain “short”?   A pacemaker stored ECG may need to be followed up with an external ECG to verify a particular rhythm disturbance.  I note they were not always able to see when you were in normal sinus rhythm because you were probably going in and out of rhythm frequently.  This happens to me a lot and is the nature of paroxysmal AF.

You need a long chat with your cardiologist to try to understand all of this.  What it actually means for you and whether there are any underlying reasons for the increased frequency of your arrhythmias?  Twenty-two seconds with an average ventricular rate of 179 bpm is not something to be messing with, since this suggests to me that your ventricular rate at times is higher.

As always New to Pace, I hope any investigations will bring peace of mind that there are no serious causes for your arrhythmias and that you can continue to protect yourself with the measures you are currently taking.

hi rate

by new to pace.... - 2022-12-08 14:46:14

Again thank you Gemita for your thoughtful answer.  I of course will ask my  questions of why at the appointment i have with the cardiologist PA., when i  see him on the 14th.  One is who requested the latest full transmission on Nov 27th?.  Which is not a normal date.  Is the time on the transmission right?  Most of these were when i was in bed asleep.  My notes of concern do not show up on this transmission.  Also Afib episodes did not happen every day.

new to pace 

From 0.2% to 0.6% cumulative atrial arrhythmia burden since your last report ?

by Gemita - 2022-12-08 16:12:09

New to Pace, I sometimes record symptoms (events) in my diary that are not confirmed during a pacemaker check which is frustrating.  This could be because our heart rate or arrhythmia duration at the time of our symptoms did not meet the criteria set up by our doctors for their recording, even though they may have been very symptomatic episodes for us.  Slow or normal speed AF can sometimes be just as troublesome as fast AF, especially when in the presence of other arrhythmias.  Benign ectopics like PVCs aren’t usually reported on, at least for me, but they can cause very unpleasant symptoms.  Of course other unrelated health conditions can cause our symptoms too, in which case our pacemaker will not store any evidence of an arrhythmia event.

New to Pace, I am like you.  The summary report in its current form is not conclusive, is poorly presented and I wouldn’t be happy with it.  Your team clearly had trouble confirming which beats were sinus beats and which were other arrhythmias, so I think with those comments alone you would need to have further monitoring.  Ectopics like PVCs can trigger NSVT and fast AF with a rapid ventricular response rate and other atrial tachy arrhythmias, makes NSVT more likely too.

If the pacemaker is unable to download data at a set time when we are in bed, it may continue to try at other times too until it succeeds.  This has happened to me.  I wonder if this is what happened but yes you should definitely query the date/time of the transmissions and the usefulness of the “unsigned” summary report?  

time of report

by new to pace.... - 2022-12-08 16:32:34

Just recieved an answer to my and now your query about the time. quoting from the email " As for the time discrepancy on  the report,. It does not neccesarily reflect the actual time the report was collected from my PM, but the time the report was transmitted, or recieved by the Carelink portal.  Most of the the time, the  stamp is equal to the report collection time, but occassionally, it the monitor cannot connect to the internet right away, for various reasons, then the report  held, by the monitor utill an internet connection can be made & the report is transmitted into the Carelink portal.  There maybe times when the Carelink portal is down, for various reasons(site maintenence, etc.), and the report is then imported once the site is available. Hope this helps" .

Does not make any sense to me,   Also makes me wonder if the times and the dates of the fast beats are even right.

new to pace

I then wrote and asked who requested this transmission?

new to pace

more info about who ordered this report

by new to pace.... - 2022-12-08 16:53:33

Just received this from the heart specialist office.  Do not think it was specifically "ordered" ,per se.  Your device does an automatic "weekly"(i was told nightly) status check on my PM and will periodically send a report for various reasons.  or the the transmission schedule changes or an alert is detected, etc.  If there were a issse we needed to see you for, you would be contacted.(i was).The person writing this was not sure which was the case, but my routine quartely is still set for Dec 20th.

new to pace

The pacemaker will keep the right time so don't worry

by Gemita - 2022-12-08 17:16:21

New to Pace, the date, time, duration and heart rate of an arrhythmia will be accurately stored by the pacemaker even though the transmission time and date may be delayed at times.  I would be confident that after a cardiac PET Scan you will get answers and hopefully reassurance.  

pacemaker

by new to pace.... - 2022-12-08 17:36:58

I know the pacemaker is doing what it is suppose to do keep an even beat an no pauses. Since i have this have not fallen.  For that am thankful.   The pacemaker working right is my only concern an it is doing that. So am grateful.

Gemita as you wrote will know after the scan on the 22nd or hopefully sooner. 

Going out to get a pizza tomorrow and  will enjoy with no worries.  Since have been eating without the reactions. 

new to pace

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