92% paced in atrium

What it means

by PacedNRunning - 2023-11-03 17:12:41

Its not that your own heart cant beat on its own at 70bpm, its that the PM keeps you from going below 70bpm.  So 8% of the time, your own heart is above 70bpm.  Your heart could probably beat just fine under 70, because most are set at 60bpm. Not sure why it's at 70. There are alot of reasons for them to set it higher than the normal 60 or lower than the normal 60. When I had mine implanted, at 60, I paced 90% of the time, so they lowered it to 45 and my pacing went down to 45%.  It's about symptom relief and sometimes just to out pace the heart because it does whacky things when it's under a certain rate.  So with them having it set to 70bpm, they are only allowing your own heart to work above 70bpm. They honestly can pace you as much or as little as possible.  It's directed by symptoms and the relief of symptoms.  

92% paced in atrium

by Heartfelt - 2023-11-03 17:27:06

Thank you PacedNRunning. I've had my pm since 2016.  I am a very active person and because I felt sluggish after the implant, my  EP set the pm to pace at 70 from 6am to 10pm, and then at 60 during the night. I also have a rate response function.  I am guessing this 70 setting is acceptable in the community. 

92% paced in atrium

by Heartfelt - 2023-11-03 17:29:36

I should add that Bradycardia necessitated the pm implant in 2016. My resting pulse the morning of the surgery was 27bpm. 

70 bpm

by Penguin - 2023-11-03 19:19:24

Hi Heartfelt, 

I've been reading your previous posts and I'm guessing you got dxd with bradycardia and low BP initially?  You were offered midrodine for low BP whilst being paced. Was this because the low BP persisted and do you still take midrodine?

You've developed atrial tachycardia since.  I have been informed that AT can occcur at rates below 100 bpm, although most SVTs are typified by rates above 100 bpm.  AF can also appear below 100 bpm. 

Couple of things which may or may not be relevant (please check with your EP): 

1. If you have low BP increasing your base rate won't necessarily help, but the midrodine should help increase your BP.  

2. The 70 bpm base rate might help with the atrial tachycardia because it might 'over pace' AT (or AF) which occurs at low rates.  Medtronic devices can't be programmed to detect AT below 170 bpm (as far as I know) and therefore they won't mode switch for AT at lower rates.  Mode switching usually helps with symptom control when you have atrial arrhythmia.  Therefore the higher base rate might be helping you with symptom control in lieu of mode switching. Check this. 

3. The general consensus, as suggested by people who have more knowledge than me on this forum, is that high burden atrial pacing isn't harmful.   92%  AP doesn't mean that your SSS is deteriorating as described above by PacedNRunning. 

 If your native / intrinsic rate runs below 30 bpm consistently, (you mentioned 27 bpm pre implant), reducing your base rate to 60 or even 50 bpm is unlikely to change this % AP. Programming your LRL lower than 50 bpm isn't usually recommended. Again check any safety concerns with your EP if the % AP is bothering you or seems unreasonable when linked to your diagnosis and what you were told to expect. 

4. Re: Rate Response I wondered whether the 70 bpm LRL may also give your h/rate a bit of a head start if it's struggling to get high enough when exercising? I've read a few peoples' comments re: Medtronic's RR not being terribly responsive in some situations. Do you find this?  If so you could ask about setting RR so that it is at it's most responsive to see if this helps with the sluggishness. 

Those are my thoughts as a layperson. You should check these things out with your EP to determine exactly why the 70 bpm LRL is programmed and to determine whether or not it's sensible to keep it in place or not. 

I hope that makes sense!

Best Wishes

92% paced in atrium

by Heartfelt - 2023-11-03 20:33:07

Thank you Penguin.

I'll follow up with my EP.