RNRVAS - Type of PMT

Repetitive non-reentrant ventriculoatrial synchrony (RNRVAS)

by Gemita - 2023-02-27 15:07:32

Penguin, I see RNRVAS is a relatively uncommon arrhythmia in patients with dual-chamber devices in atrial tracking mode and may be missed by routine device interrogation.  Reprogramming is important to prevent symptoms and triggering of atrial tachy arrhythmias like AF. 

You say there are no algorithms available to treat/detect RNRVAS, but I am assuming that a good cardiologist/EP will be able to confirm whether this device related arrhythmia is potentially present and causing your problems and that a good Manufacturer rep will be able to successfully identify this arrhythmia if present?   I am aware that RNRVAS is known to commonly occur in Abbott devices.

I wish I could help you to identify your arrhythmia to relieve your symptoms and to take away your fear that this might lead to more serious conditions in the future, but sadly I cannot.  I can only describe what my own arrhythmias feel like and we can exchange symptoms, but I have had the benefit of 3+ years of Reveal Linq Implant monitoring to help me and my doctors identify/confirm my many arrhythmias.  I have also had the benefit of an EP study in the Cath Lab where they ruled out AV Node Reentrant Tachycardia.  I had a 4 wire study and was in AF at the time.  They were able to diagnose the exact spot from where my AF originated and were able to rule out any abnormal conduction pathways.  If you had an EP study and ruled out everything else, that would be a start.  I don’t know what else to suggest other than asking once again for a thorough interrogation of your pacemaker with the manufacturer rep present to see whether your problems can be identified?  

Any further news on the possibility of getting a device replacement Penguin?  If you have the strength, please keep up the fight for a better quality of life and keep us updated on your progress.  You are a very special case and we can all learn a great deal from your unfortunate experience.  We will be with you every step of the way xx

PVC-induced PMT

by Gotrhythm - 2023-02-27 16:35:11

I was diagnosed with PVC-induced PMT. It took two years to diagnose and then only after I gave up on my local EP and went to Duke. I had Holter monitor tests but they only showed a lot of PVCs. Otherwise the ECG was completely normal. Even at Duke, the EP was only able to diagnose it by watching the ECG as I exercised, and that happened only because earlier I had deliberately let myself collapse in the presence of a tech.

If PVC-induced PMT is what's going on, I feel for you. It's frustrating and scary to feel something happening, maybe getting worse, feeling like this once the problem is the pacemaker, but be unable to get real help.

Unfortunately, describing my feelings probably won't help you and might just send you down a rabbit hole chasing the wrong rabbit. Many different arrythmias will produce the same or very similar feelings.

The difficulty is that the doctor cannot treat what he cannot see. What you can do is try to observe your spells (for want of a better word) until you can predict them. And then create a senario in which they happen in the presence of the EP. In my case, I could prime the pump so to speak by walking up several flights of steps, in the NC heat, and then walking fast for 100 to 200 feet. I did that for 30 minutes before my next EP appointment.

You say your spells come on in the evening? Okay, that's a starting place. See if you can figure out how to make them happen. Then figure out how to let the EP see them happen.

Hope you get some answers soon.

PS, I did not then and I do not now have a-fib, although it was suggested several times.

PVC-induced PMT

by AgentX86 - 2023-02-27 17:06:17

Gotrhythm, that's very interesting.  My cardiologist hinted that there may be some AV connection showing its ugly head.  It didn't make much sense to me at the time because I'm paced VVI.  Perhaps he was thinking about retrograde conduction (PVCs galore).

Empathetic Response

by Penguin - 2023-02-27 18:43:55

Thank you very much for your understanding and empathetic response Gotrhythm. 

Frustrating it is indeed - and exhausting.  

I'm at a loss as to what's going on. I can relate to what you say as AF doesn't show up on a Kardia mobile, yet the 'arrhythmia' responds to all AF triggers and it appears to be AF from that perspective. I can't see that an EP study would help if it's pacemaker mediated - until it's done further damage of course.

The (sort of) helpful news is that the symptoms are getting easier to reproduce. I've been doing some activities during the day which seem to cause leaping around feelings in my chest and my resting pulse when the episodes occur in the early evening is getting higher (up to 90 bpm the other day whilst sat watching TV) which is highly unusual for me.  

I think it's one of those situations that is difficult to understand until you walk in that persons' shoes and it sounds as if you've trodden a similar path.

I appreciate your support GotRhythm. It's pretty tough currently.

PVCs and long AVDs may be relevant AgentX. Both are related to programming.  

Best Wishes

EP Study

by Gemita - 2023-02-28 01:34:30

Penguin, since you do not have a confirmed diagnosis of PM mediated arrhythmia and are so symptomatic and concerned about the possibility of having AF, I thought an EP Study, however invasive, might at least be worth mentioning.  Invasive studies can be of value in symptomatic patients whose symptoms do not always occur during monitoring.

When my EP offered to do a Study “prior” to any ablation, he was looking for additional information that he couldn’t get from any other monitoring source.  During the Study he was able to determine the right medication and dosage that could control my AF.  The Study also picked up intermittent Bundle Branch blocks and SVT with aberrant conduction which appeared to be VT episodes on a surface ECG.  So they can learn a great deal more from this invasive Study, if it is indicated in the future.

AgentX86, you mentioned your cardiologist hinted that there may be some “AV connection showing its ugly head”?  Not sure what you are saying.  Is your AV Node ablation showing any signs of breaking down by chance and letting signals through to push your ventricles?  I see from your original post the device technician even suggested an ablation in the ventricles for your PVCs.

Take heart

by Gotrhythm - 2023-02-28 13:21:05

Penguin--Finding it easier to produce symptoms is definitely a good news/badnews situation. There's a difference between an erratic arrythmia that we just need to learn to live with and one that is both unidentified and getting worse. The difference is in how alarmed it's rational to be. But take heart (pun intended.) If you can make it happen in the presence of your EP, you will be most of the way to correction of the problem.

If it is PVC-induced PMT, a tweak of your pacemaker settings will take care of it. It's a problem that can be hard to diagnose but easy to fix.

AgentX--Your EP sounds really really smart. My problem happened around nine years and I no longer remember the details of exactly how the errant pathway was causing the sensing function to go awry, but the symptoms I felt were the result of V-pacing at a moment when it wasn't actually needed.

Not alarmed

by Penguin - 2023-02-28 20:08:46

Gotrhythm

Thank you for your response.  I do have this in perspective believe me.  However, I'm extremely tired and pretty desperate for some answers though.  Every so often I get a worse run of symptoms. This week-end was one of those times. I've not had much sleep and that never sits well with me. 

PVCs are not something I've had trouble with over the years. However, you may be onto something as they suddenly shot up in number from approx 2k over 14 months (with no symptoms) to approx 6k over just one month (and then symptoms began).  I don't know if they've increased since. 

I have long AVDs in place and a v.lead which wasn't tested for some reason at my last clinic visit (unusual) and so I'm listening to your experiences with interest.  Perhaps the sensing on this lead needs to be looked into. Thanks for that nugget of info.

I was hoping that someone might have experienced RNRVAS. I happened across it when trying to make sense of this but it was a long shot. Thank you all for your input. Appreciated. 

Yes me’

by PacedNRunning - 2023-03-02 04:52:00

I had this and my Kardia ecg tracings looked just like it. I had long AV delays as well 250-300ms and low lower rate limit 45. Shortening my AV delay resolved It. I felt continuous thumping or palpitations. Awful! We tried to minimize pacing. 

Kardia ECGs

by Penguin - 2023-03-03 13:40:32

PacedNRunning, 

Problem is I wouldn't know how to recognise RNRVAS on an ECG ! Did Kardia confirm it or did you recognise it yourself?

I've had the thumping feeling (usually a big one off thump) but more usually a trigger (food, positional) then continuous palps that won't stop once they start and run like a hamster on a wheel once they start.

My lower rate is a pretty normal 60 bpm - no hysteresis. AVDs are longer as discussed before. 

Spoken to someone about reducing my AVDs again but the message keeps coming back that the AVDs are not doing any harm and need to be that long to prevent VP, although my PR is mainly normal and VP is low.  It makes sense at the time and then I walk away and wish I'd pushed harder to have them removed.

I'll keep pushing! Thanks x