Medtronic Azure Settings - Advice Please

You ask some challenging questions - my personal experience with Medtronic Ensura

by Gemita - 2023-01-21 09:37:13

Penguin, not sure that I can answer your specific questions on MVP and NCAP as well as Medtronic Academy (my go to place for Medtronic settings info, see links below).  My device though is a 2018 Ensura dual chamber pacemaker, but it has many similar programmes running to the Azure, I have no doubt.

Managed Ventricular Pacing (MVP):  In simple terms, this setting seems to allow us to miss a beat before the pacemaker will pace us, to help minimise ventricular pacing.  It essentially pauses and waits to see if our own heart beats before it paces.  Pausing, however minimal though appears to be a major trigger for my fast arrhythmias like AF, particularly during any atrial premature beat/ventricular premature beat activity.  I am trying to see whether my clinic will consider turning MVP off, so that my slower, pausing beats can be outpaced more effectively - known as overdrive pacing.  

(Please see link for Azure MVP settings enhancements:  Azure pacemakers, Percepta/Serena/Solara CRT-P, and Cobalt/Crome CRT-D devices – MVP does not wait until the next A-event to detect loss of AV conduction (it learns the patient’s conduction to best adapt to it, similar to Search AV+). If the V-sense is late, relative to recent AV conducted events, MVP will pace the atrium and then pace the ventricle with a PAV of 80 ms. The atrial pace provides AV synchrony to be maintained and prevents retrograde conducted events. This MVP enhancement reduces the V-V length following AV block or PVCs).

Non Competitive Atrial Pacing (NCAP): A similar thing happens with NCAP as with MVP.  NCAP is a setting to help stabilise atrial rates and prevent atrial tachy arrhythmias by avoiding pacing after an atrial premature beat which doesn't work for me at all.  I want settings which outpace (overdrive pace) my pausing, slowing beats, not settings that tend to delay pacing, if that makes sense.  

Of course the downside of switching off MVP or NCAP would be that my ventricular pacing % will increase.  However, because the atrial premature beats always always lead to AF, which can be so difficult to tolerate, cause pacing difficulties and trigger frequent mode switches, this might be a price worth paying - at least for me.

As you know I am currently in discussions with my team regarding my Settings.  Both Atrial Preference Pacing (APP) and (NCAP) are algorithms which are turned on in my pacemaker, both of which are supposed to help prevent atrial tachy arrhythmias but only APP appears to do this because of its capacity to “overdrive pace” as opposed to NCAP which avoids/delays pacing after an atrial premature beat. 

With a new Azure pacemaker you will have much more in the way of anti tachycardia pacing algorithms like perhaps atrial rate stabilisation or rate smoothing to play with.  Of course we are a long long way from expecting our pacemakers to help control arrhythmias like AF, but many settings may not benefit us in the presence of an arrhythmia like AF and might just need adjusting or even turning off. 

I am sorry I cannot help further with your difficulties since these will be individual to you and you will need to study what settings need adjusting to help treat your particular symptoms.  Personally I don’t think there is much in it between the two pacemaker manufacturers you are being offered.  There are pros and cons with both.  I am happy to be with the main manufacturer, but I can see many members are successfully paced with other brands that may be better for some individual activities than Medtronic.  A difficult decision.

Tachy arrhythmia detection: as far as I am aware parameters for detection of a tachy arrhythmia can be individually set and adjusted by your technicians.  This is what I was told for both myself and my husband who also has an Ensura pacemaker.  However they like to keep the detection rate high to avoid unnecessary alerts of lower rate tachy arrhythmias.  Also by keeping the thresholds high for their recording and storage, it will only happen when an event is of significance (to your doctors).  Keeping the parameters set high would also avoid frequent mode switches, but this is another story 

https://www.medtronicacademy.com/features/managed-ventricular-pacing-mvp-feature

https://www.medtronicacademy.com/features/non-competitive-atrial-pacing-ncap-feature

https://www.medtronicacademy.com/features/atrial-preference-pacing-app-feature

Challenging Q's

by Penguin - 2023-01-21 12:12:35

Hey Gemita, 

Apologies for the challenging Q's. I ask because reading manuals is like reading in Arabic sometimes. I'm probably asking for an interpreter! Perhaps that's unfair - sorry.

 Sales talk is impressive but once the gloss is removed, the nuts and bolts of how these settings actually work (against each other and in harmony) are far more helpful. Your personalised insights always help me. 

I understand that you need to find out more yourself too, so I totally respect your limits.  The links are great - thank you very much. 

settings

by new to pace.... - 2023-01-21 15:21:02

I understand that you have a pacemaker that you are not happy with.  If it is working well for you, why don't you wait until it needs to be replaced.  By then possibly your concerns might be met, with the new model or change of brand.

You are stressing your self to much over this now.

I am trying to control my AF by eating right.  As i checked the last quartely remote transmission against my food journal. Found out my AF epsiodes  have been after eating pizza.  Have stopped eating pizza for now and will see next quarter, if I am on to something.  As i am trying to avoid medication.

This method does not work for everyone, so far it is just fine for me.

new to pace 
 

Pizza

by Penguin - 2023-01-21 17:05:23

Sorry to hear this, but good that you've possibly tracked down a reason. Fingers crossed that you achieve your objective. 

Stressed? Just asking Qs that may be helpful later. 

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