CRT-D adjustments today and update

I saw my EP today and he was happy to adjust my lower rate from 60 to 70 on my CRT-D.  He also adjusted the rate response to make it more sensitive so I hope my heart rate will respond to a higher rate than 70 when walking or climbing stairs.  I will get the device checked in 6 weeks on one of his patient days and he will look at the adjustments with me.  He told me to call the office if I am feeling worse.  I have had no ventricular arrhythmias, but lots of non-sustained tachycardia and a high number of pvcs.  My battery dropped from 6 years to 5 years over the past month!  It was newly implanted in mid December.  I'm 100% paced in all 3 leads.  My 2-lead ICD lasted 6 years.

I take sotalol for an antiarrhythmic and the dose has had to be reduced over the past 6 months due to elongated Q-T wave....from 160 mg 2x/day to 160/120.  He may have to reduce the dose again, which concerns me, as I will have more arrhythmias--it's as high as he wants to see it.  It protects me from ventricular arrhythmias as well as other arrhythmias.  He said my only other choice would be amiodarone.  I told him that I would like to stay on the sotalol so he will watch it closely.

I see the cardiothoracic surgeon Tuesday and hope to get cleared from lifting and movement restrictions following my pocket/chest infection after relocation and new device implantation.  I am so fortunate the infection never got into my blood!  I will be seeing him regularly to check my leads, as I have no heartbeat from my SA node, found when he tested the leads during the implant. He said I also have BBB, which I was unaware. He assured me my leads would not completely stop working.  His specialty is complicated heart and lead devices and infections.  

I am feeling more optimistic and look forward to travelling this summer, getting back to work and having fun!




Reassuring update

by Gemita - 2023-02-21 04:20:09

Islandgirl, you do sound as though you had a good outcome yesterday and I hope you will find, like me, that a higher lower rate setting of 70 bpm will be beneficial.  In fact you might find that it will help reduce your total number of atrial and ventricular arrhythmias, including all the benign ones like PACs and PVCs.  PACs I find often trigger other arrhythmias like AF and if AF occurs with a rapid ventricular response, it is easy to understand how this could trigger non sustained, or even runs of sustained VT and perhaps cause an inappropriate shock which you really don’t need.  

I have found a higher rate setting has done more to help control my arrhythmias than medication ever achieved (Flecainide, Digoxin and Bisoprolol), so I think your EP is spot on wanting to reduce your Sotalol.  The long QTs won’t be helping and Sotalol appears to be worsening this condition, so has become pro arrhythmic it seems?

I wouldn’t feel concerned about the battery life just yet since we know it can show wild fluctuations until we get nearer to end of battery life.  In any event if you can settle your arrhythmias, giving your ICD/pacemaker less to do, you may automatically reduce battery drain, so that is where I would focus my attention.

I have intermittent bundle branch blocks too although I was told that ventricular pacing itself can sometimes produce a bundle branch block type paced QRS complex pattern on ECG, so when you see your cardiothoracic surgeon and/or EP next, I would ask them what this finding means for you personally, whether it is caused by ventricular pacing itself, lead position, or whether it signifies something else?  The more we learn the better.

So pleased your infection has resolved;  that is the most important news you could have given us.  You are certainly in safe hands and I hope you will enjoy some happier times ahead.  Really great news and thank you for sharing this with us xx

Good report 🌸💞

by Lavender - 2023-02-21 10:31:37

I'm so glad you have such wonderful guidance from your medical team. So good knowing your infection has cleared and you're already making plans to resume a rewarding and fun life!  Yay!!😘

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I finished 29th in London in 2 hours 20 minutes 30 seconds which is my fastest with or without a device so clearly it didn’t slow me down ! I had no problems apart from some slight chaffing on my scar - more Vaseline next time.