NIPS Options

NIPS (non invasive program stimulation) options

by Gemita - 2023-06-27 07:47:04

Penguin, from what I have read, NIPS is an electrophysiology study that checks the electrical activity of the heart when we have an ICD.   NIPS is performed directly after having had a defibrillator implanted in your heart to ensure it is working properly and will hopefully not trigger inappropriate shocks; for example an inappropriate shock from an atrial tachy arrhythmia.  Is this function available to you on your current device? 

I believe it is often used after an ablation for VT to determine the success of the procedure.  It can be used as a guide for repeat early ablation, to offer better programming of ICD, to offer prognostic value regarding VT recurrence, and to guide antiarrhythmic drug therapy.  The noninvasive nature of NIPS makes it attractive to obtain prognostic value regarding the occurrence of VT.  It is certainly worth asking about if you have this function??

I still feel long term holter monitoring, Zio Patch or Reveal Linq implant monitoring would also be good choices, all of which would capture what is going on, even if at slower rates, irrespective of what parameters have been set up by your EP in your device.  Whichever way you go, it is all about monitoring, monitoring, monitoring and getting that evidence you so desperately need.  

VT Detection is normally set at >150 bpm.  Mine is too.  You could ask about having this set lower to pick up slower ventricular rates or have other sensitivity settings adjusted so that more tachy arrhythmias will be seen/reported coming from both the upper and lower chambers.  I know my SVT was a frequent trigger for my NSVT episodes, but it needed an opinion from a Medtronic technician to sort these two arrhythmias out + further external monoitoring. 

So do use whatever you have at your disposal to help identify the arrhythmia Penguin and keep asking those challenging questions

Gemita

by Penguin - 2023-06-27 11:42:13

 Gemita, 

Thanks for clarifying how NIPS is used and the heads up on usual VT detection parameters. 

I do seem to have NIPS as a function / setting on my device !! Bit confused as to how the setting might be used - during an EP procedure or via the PMs own diagnostics ??? No idea. 

I have a PDF showing the product specification for Assurity Pacemaker / Abbott which lists all of the available settings under various headings (page 4 of link below). 

https://operativa.sk/wp-content/uploads/2020/10/crm_product_catalog-PM.pdf

Under 'other settings' it lists various things including Lead Monitoring, Corvue Congestion Monitoring, Magnet Rate and 'NIPS options'.  The NIPS options / settings are then listed.  I enclose the PDF link. 

None of this means much to me at all, but I just wanted to know what my device might be able to find out for me!! 

Advice heeded re: Reveal Linq etc. but v.doubtful that I'll received any of that!!

NIPS function appears to be available

by Gemita - 2023-06-27 13:50:27

Hi Penguin, Yes you do seem to have this clever little function.  I thought at first it might be something you could turn on and off, to use with an upgraded device/defibrillator should you need one in the future, but they are clearly showing this function as available for use with both the single and dual lead Assurity pacemakers.  

It seems they can stimulate both the atrial and ventricular chambers to try to trigger an arrhythmia like VT but in a controlled clinic setting where you will remain safe.   I am not sure what the indication for such therapy would be other than for the reasons I have already given in my earlier comments.  I would imagine there would need to be a good reason to use the NIPS function because otherwise you could perhaps end up with more frequent runs of an unwanted arrhythmia if you push your heart too much, too often, during a NIPS challenge as a means of learning more about any “potential” VT episodes.  The whole point of a NIPS study though would be to do just that;  to find where the arrhythmia is coming from and whether it could be amenable to ablation or medication treatment.  

Unless episodes of SVT/VT have been confirmed by external monitoring/surface ECG and need to be fixed, I am not sure that they would want to push your heart potentially into VT in order to make such a diagnosis though?   

You say "Bit confused as to how the NIPS setting might be used - during an EP procedure or via the PMs own diagnostics"??  It seems to me Penguin it is part of the pacemaker's own diagnostic functions, ready to be used on an as needed basis (?providing there is a valid indication for such a Study).  With this build in function, you wouldn't perhaps necessarily need to have an additional invasive EP study with catheters into the heart, to get this valuable information, so certainly worth asking about

VT

by Penguin - 2023-06-27 15:32:22

Thank you for your response. I had similar thoughts. 

It does seem to be a pretty nifty function if it works how we think. Perhaps someone else on this forum might know whether or not we are on track with this?

I have a full technical manual and this describes other diagnostic functions which determine whether SVT is the reason for -> VT.  As far as I can see the diagnostic function hasn't been applied to my evidenced SVT / VT  in any paperwork passed on to me.  That would seem to me to be a sensible first step perhaps. Other causes for VT haven't been discussed either.

I agree that EP studies / ablations etc need sufficient reason.  I'm not at that point and agree that I don't have enough of the valuable information you refer to. 

Thank you for your thoughts.