Update on VP %

Yesterday I had my annual appt. With Medtronic rep ( turned out there were 2 present ) as well as my 6 month doctor visit. Recently I'd been concerned about a steady increase in ventricular pacing- the highest being 78%. They told me the same thing my doctor has told me in the past- those numbers change a lot and  that I'm doing fine. Battery life of 9-10 years remaining. I've had my PM 3 years in May and thankfully enough, I haven't developed any arrhythmias. I do have the occasional PVC and PAC though. My diagnosis continues to be "intermittent 2nd and 3rd degree heart block." I'm grateful to be doing so well and will attempt to stop being such a worrier...Good luck with that !

 


17 Comments

Did you ask about MVP (managed ventricular pacing)

by Gemita - 2023-03-01 07:50:12

Dixie Chick, thank you for the update.  I didn't think you had any reason to worry since you had been feeling so well and that is usually a clear sign that all is usually well.  I am very happy for you.

Just to make you worry again, did you by chance have the opportunity to ask about the MVP  setting being turned OFF, or do you have any further news for us on this.  Just interested, nothing more, since I am trying to learn as much as I can about my own settings.

9-10 years battery life on a 3-year pacemaker sounds great.  Mine is coming up to 5 years old and I apparently have 4 years remaining but I do keep my little device busy controlling my arrhythmias unfortunately and I am sure that makes a big difference.  Anyway such good news for you and well deserved too

MVP and ventricular pacing

by Dixie Chick 65 - 2023-03-01 10:01:34

I did ask the Medtronic techs about it and basically they said that MVP is used with people that use VVI pacing. My DDD pacemaker is better suited with MVP off. Not sure I'll ever understand it but I'll take the professionals word for it, since all seems to be good.

Gemita, it's great to hear from you and I continue to wish you well

MVP and ventricular pacing

by Gemita - 2023-03-01 10:44:57

Thank you Dixie Chick.  Well since we both have Medtronic Pacemakers, here is the official Medtronic Academy info on the Managed Ventricular Pacing feature which reduces unnecessary right ventricular pacing. 

As previously mentioned, I am 100% AAI (atrial) paced for Sick Sinus Syndrome and have MVP switched ON to avoid unnecessary right ventricular pacing.  You clearly have heart block and need a high % of right ventricular pacing as well as some atrial pacing, so I was very interested in your technician's response.

My husband has a single lead Medtronic PM to his right ventricle and has VVI pacing, although he still has an intermittently functioning right atrium with persistent to permanent slow Atrial Fibrillation.   

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

MVP and Pacing percentages

by Dixie Chick 65 - 2023-03-01 17:58:41

Yes, Gemita, I read extensively on the Medtronic website and I understand why your MVP is on. This technology simply amazes me. 
It never fails that my heart rate goes crazy in the doctor's office. It was 118-120 bpm the entire time I was talking to the techs. I'm not outwardly "nervous", I try taking deep breathes but it stays high. All the time I'm having regular conversation with them !  Finally by the time my doctor came in, it was down to 104 bpm. 
All the best to you and your husband.

MVP terminology in Medtronic vs Boston Scientific

by Rch - 2023-03-01 19:09:54

AV Search+ and RhythmIQ are the 2 parameters in Boston Scientific PMs that control unnecessary RV pacing. The reference guide on Boston Scientific website explains how these work in AV blocks. 

And The Technology in St. Jude Pacemakers

by Marybird - 2023-03-01 19:55:40

Is called Ventricular Intrinsic Pacing or VIP. 

There is quite of information about this on the Abbott website. I also read about this feature in the instruction manuals on this site ( for pacemaker technicians use in initial and later settings)- not that I could understand that much of it. As I understand it, though, this feature allows for some extra time after an atrial beat ( paced and/or intrinsic, not sure) before the pacemaker paces the ventricle to allow for the intrinsic ventricular response. This minimizes ventricular pacing when the AV and conduction system is intact. 

Like Gemita, I also have SSS ( tachy-brady) but apparently my conduction system and AV node were initially ok, so I was paced at about 95% atrially, and the VIP mode on ( don't know the setting), so at 0% ventricular pacing. But last September, during an in office pacemaker check, the technician noted there were a number of pauses after the atrial pacing, had gone on for some time. She said it looked as though I was developing some heart block, and she made some setting adjustments ( I think it may have been with the VIP mode, but I don't know if she turned it off or decreased the wait time) and said I'd be pacing in the left ventricle as well as the atrium. I haven't seen any remote reports since then, but I feel ok. 

New onset heart blocks

by Rch - 2023-03-01 23:41:25

Marybird, Just my opinion: The device tech should have consulted the Cardiologist and done a surface 12 lead or a holter to determine the type of heart block, and if they are of new onset, some Cardiologists also recommend a myocardial perfusion scan to r/o CAD. 

A minefield

by Gemita - 2023-03-02 04:55:10

Marybird and Rch, your comments serve to confirm the many differences that exist between manufacturers when describing their own particular pacing algorithms.   This is so confusing for patients, particularly if we want to do a direct comparison between manufacturers of what each algorithm does.  

Yes Mary, my Medtronic MVP feature does indeed wait for my own heart to beat after any short atrial pause before it steps in to pace me in the right ventricle.  I was told though that at my 70 bpm Base Rate, long pauses (more than 3 seconds) just wouldn’t be happening (even though it feels like it at times).  Mary, did you mean you will now be pacing in the right ventricle as well as the right atrium since you typed “pacing in the left ventricle".  I don’t think you have a third lead?  

At my last device check I did in fact ask about turning off a number of features, including MVP, to help with the pauses that occur after premature atrial beats, pauses that are a frequent trigger for my Atrial Fibrillation. I was told MVP switched ON was appropriate for me since I do not have any significant heart block.  However, they confirmed that they would never minimise ventricular pacing in the presence of a high grade block.   

Dixie Chick, I have the opposite problem, whenever I see the doctor, my heart rate/rhythm are usually perfect, but the moment I leave the consulting room, things can rapidly change.  I hope your heart rate is well controlled most of the time and they didn't need to increase your meds?

MVP

by Dixie Chick 65 - 2023-03-02 07:26:23

Good morning, Gemita

Yes, thankfully there were no changes in my medication. And the high heart rate finally came down to almost normal while I was talking with my doctor. I know both the techs and they're very helpful in answering questions, etc. One of them was present when I got my PM. The other one I've seen 3-4 times. That crazy heart rate is embarrassing!! Guess they're all used to it now. I keep thinking as time goes by it will get easier, but so far it hasn't !

All the best to you, Gemita

Yeah, Right Ventricle

by Marybird - 2023-03-02 10:57:24

My bad, Gemita, typed left when I meant right ventricle. I have two leads, not three, and I hope I never need three. Good catch! 

Rch, I know investigation of a possible new onset heart block is a good idea. But I had extensive testing several years ago, just before I got my pacemaker, including nuclear stress testing (×2, a year apart)  a cardiac cath, echocardiogram, and the cardiologist said at that time there was no evidence of coronary artery disease- he commented that my coronary arteries looked like those of a teenager. I'm thinking with any luck it's not likely that significant coronary artery disease has crept in since then and has caused heart block since then, more likely any heart block is caused by progression of the SSS with which I was diagnosed just before the pacemaker placement. The pacemaker tech sends any pacemaker reports to the cardiologist I see, I've seen him for a number of years so he knows my history- he's the guy who did all the testing. Though the next time I see him we will have a conversation about pacemaker report findings, in the past he's seemed more concerned about the A-fib so I will ask about possible heart block. But wouldn't pacemaker settings compensate for that? 

Dixie Chick, I'm with you about not understanding all that much about pacemaker settings, pacemaker features that allow our hearts to do their own thing as they are able. Sounds as though you have good support though, and with time, more answers to questions you may have, and explanations you will understand more, I think. 

As I ( somewhat) understand it, the feature that delays ventricular pacing for a bit of time after the atrial signal, whether it's called the MVP, AVSearch, Rhythm IQ or VIP, is intended to maximize the person's own intrinsic ventricular response in a person with SSS, but an intact AV node and conduction system. This feature can be turned off ( or perhaps set on a lower setting to decrease the delay?) to eliminate or shorten this delay if there is evidence the person's own intrinsic ventricular response is longer than it should be, or intermittently not kicking in, or no longer functioning reliably. 

At least that's my understanding. 

I would ideally like to get my hands on all my Settings

by Gemita - 2023-03-03 05:31:37

Marybird and Dixie Chick, I am with you both, I understand precious little about my Settings although it is clearly a work in progress.  And the more I learn, the more I feel I still have to learn. 

Mary, your understanding/definition of managed ventricular pacing across different manufacturers is an excellent one and I will adopt it.  Not sure how each manufacturer feature on managing ventricular pacing fully works with regard to timing or delay of any response but no doubt it works in combination with other Settings too like AV delay, so managed ventricular pacing won’t be working in isolation and changing any of its "timing" Settings could certainly affect other Settings too. 

I just wish I could get a full copy of all my Settings at some stage to learn more about what I have set up, although the technician I last saw felt it was unnecessary for me to understand about these things, suggesting that it might be best to leave it to them.  Perhaps they have a point ?

Those settings !!

by Dixie Chick 65 - 2023-03-03 09:31:18

Gemita and Marybird, thanks for your comments and suggestions. Very grateful for the people on this forum and their willingness to share and explain with us all. 
 

Whitecoat syndrome

by Lavender - 2023-03-03 09:56:35

My blood pressure is normal to low. However in stressful situations and especially in the dr office-I definitely get whitecoat syndrome. They marked it on my chartšŸ¤£

Now, before visiting the dr, I am advised to write down a few day's history of blood pressure and pulse...taken a various times of the day. I bring it along to show them that I am normal-at home! Lol

AAI-DDD Settings

by Penguin - 2023-03-03 13:58:31

Pleased all was well Dixie Chick and your settings are appropriate.  Once AVB is involved my knowledge goes south! Still learning myself. 

Empathy re: the crazy BP. I used to feel really tense before pacing clinic encounters too - still do tbh. I'm sure they're used to patients feeling that way, so try not to worry about it too much.  

Best Wishes

 

 

Marybird

by Penguin - 2023-03-03 19:06:49

You can find an explanation of the VIP algorithm here.  I found this after my device was implanted and was quite shocked to read this: 

https://www.cardiocases.com/en/pacingdefibrillation/specificities/pm-pacing-modes/abbott/pacing-modes-specific-abbott

'There is no specific mode per se to reduce the percentage of unnecessary right ventricular pacing in Abbott pacemakers. The VIP algorithm corresponds to an AV delay hysteresis*. '

(*Hysteresis is a programmable feature that allows the pacemaker to begin ventricular pacing only if the spontaneous rate falls below a set rate usually expressed as a % reduction e.g. 10%; then pacing continues at the programmed base rate (60 bpm) unless intrinsic ventricular activity is sensed.)

This is different to the modes that most manufacturers use e.g. an AAI - DDD mode.  AAI-DDD modes mean that the PM paces mainly in the atria (AAI) and only switches to DDD on defined criteria. This mode keeps pacing for SSS mainly in the atria (where it should be!) and reduces the unnecessary v.pacing which the DDD mode causes.  

Abbott's VIP mode is different because it doesn't operate in AAI mode and is already in DDD mode. Therefore the VIP algorithm can't mode switch to DDD.

AAI-DDD modes were considered to be the gold standard for removing VP some time ago. Abbott's method was 'different' because they stuck to DDD pacing rather than adopting an AAI-DDD mode.

  In terms of effectiveness I don't know how Abbott's method of controlling VP stacks up, but it's technically not the same as MVP and the other AAI-DDD algorithms. 

I hope that makes a bit of sense. It took me long enough to find out about it - let alone understand whether or not it was going to be helpful. 

Thanks, Penguin

by Marybird - 2023-03-03 23:01:14

That's great information in your linked references- I bookmarked it to re-read, look around the site. It's a great reference for comparing the similarities and differences between the different manufacturers's pacemakers. Or it would be if I understood all this stuff much better than I do now. I'd have to improve a lot to get to the level of even the Pacemakers for Dummies book that was mentioned earlier on the forum! In any case, I really appreciate your explanation and the references you linked.

I think I can see where the Abbott VIP is different from the Medtronics and Boston Scientifics algorithms for enhancing intrinsic ventricular pacing. But the details, I'm afraid, are beyond me. I know the pacing tech I saw last September commented about pauses she had seen on the pacemaker reports, and she made changes in some of the settings which she said would result in some ventricular pacing in addition to the approximately 95% atrial pacing that's already there. I'd assume that these adjustments were meant to reduce the AV delay time time between the paced ( and/or sensed, but mostly paced) atrial beats and ventricular responses, but I have no idea what settings were changed, or how much. I haven't seen any reports since then ( there would have been a remote monitor report in December 2022, and another one coming up in about a week or so ( March 9), but I haven't asked to see them, and they don't provide results unless you ask. I'm doing ok, feel good otherwise, so figure I will ask about it when I see the cardiologist again.

Thanks again, for the information!

White Coat and AAI-DDD

by AgentX86 - 2023-03-04 00:36:31

Lavender, one thing to try to aleviate white-coat syndrome is to do breathing exercises before they take your BP.  Draw in a deep breath, slowly, the exhale slowly.  This will turn down the sympathetic nervous system (fight/flight) and put the parasympathetic (rest/digest) system back in control.

AAI->DDD:  This doesn't make a lot of sense to me.  The whole point of DDD is dual pace.  The atria doesn't pace unless the delay is exceeded (fixes SSS).  Then the ventricles don't pace unless the AV delay is exceeded.  AAI just means that nothing happens if the AV node forgets to work.

You know you're wired when...

You can hear your heartbeat in your cell phone.

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