Follow-up after first EP Clinic appointment today

Hello, Everyone,

I learned quite a bit today at my EP Clinic appointment that hopefully will help me feel better. I started my discussion with describing how I felt.

My rate was changed from 60-130 to 50-110 to help reduce the spike in heart rate I feel when I initiate activity.  If I feel I need a change, I can make an appointment and the Biotronik rep will be there. 

My atrium is pacing at 80% and my lower chamber at 9%.  The tech explained that the 80% pacing in my atrium is trying to mimic my sinus node. 

I asked the tech if there were any concerning events that my pacemaker revealed and she said none at all. 

I was concerned about my PVC burden and was told that it is less than 1%.  The NP said that at my age (I just turned 70), that is no cause for alarm.  The tech said that getting PAC burden info. was much less clear cut. 

Since I have episodes of lightheadedness and have had a positive tilt table test in the past (which my cardiologist diagnosed as vasodepressive syncope), the NP took me off of Diltiazem and prescribed 1/2 of a 25 mg Metropolol tablet every morning.  She wants me to continue with the 200 mg Acebutolol every evening.  I was wondering if perhaps I was overmedicated when my cardiologist doubled my Diltiazem when I told him about the spike in heart rate with activity.  The NP said that was the pacemaker contributing to the spike and that I probably did not need the increased dose.  Also, she explained that with the positive tilt test, Diltiazem perhaps wasn't the optimal medication but that another beta blocker at a very low dose might help.  I had a feeling that perhaps the medication might be working against me.  I guess that might take a few days to figure out.

My medical records indicate that I have "unspecified syncope" with PVCs and palpitations  The NP told me I have sick sinus syndrome. 

I am so grateful for all of you who offered advice! It was very helpful in framing the questions I posed today.  I realize that having a pacemaker is like learning a new language.

2 Comments

It’s all good

by Lavender - 2023-10-10 22:35:32

Yes, learning about our pacemakers is a whole new world. When I joined, I told Gemita that it was like I was in kindergarten and she was a college grad. 
 

I have read your posts.  I'm not the tech expert but I'm here! Good luck with your new settings and med changes! 

Thank you for the update

by Gemita - 2023-10-11 08:38:34

Hello Ukegirl, thank you for the update.  You seem to have covered a lot during your appointment and I hope some of the changes made to your settings will help.  

I note your PVC (premature ventricular contraction) burden was low but that your PAC (premature atrial contraction) burden was less clear cut.   Not sure what was actually seen or what this means for you so it is difficult to know how to comment.  It can sometimes be difficult differentiating PACs from other atrial arrhythmias present since PACs can come in quite fast at times.

Still on the subject of PAC burden, my Medtronic Ensura pacemaker does not unfortunately provide a PAC count or store this information on my device as it does for any PVCs.  I asked my clinic why and was told that this was because of the Medtronic report design, over which they had no control.  They couldn’t explain why Medtronic had provided the ability to see counters for PVC singles/runs on the device report but not for PACs so I have some work to do to try to find out.  

I am glad your EP has confirmed the spike in your heart rate was likely caused by your pacemaker rather than by any arrhythmia.  I see these spikes initially led to the prescribing of a higher dose of Diltiazem.  Hopefully your medication has now been adjusted and you will start to feel so much better.  

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