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Answers from EP Questions, I am happy.
- by ANDREW75
- 2023-12-12 14:29:03
- General Posting
- 456 views
- 7 comments
Pacemaker Answers from “Andrew’s EP” and “Tim the Tech”. Dec 11th 2024.
Biotronik DDD-CLS, with Adaptive Rate Response turned on.
1/ What is my diagnoses? I know I have Bradycardia - low pulse and PVC’s. What about Sick Sinus/ Heart Blockage and other symptoms?
Answer: “Sick Sinus-Bradycardia.”, with daily PVC’s.
Can I have my settings changed please, what would you recommend? I have been reading up and studying my condition. The Pacemaker website you recommended is great and the pdf report that Tim gave me is really helpful,
Answer: No, he was worried about increasing my pace above 130 it would be dangerous. He does not want me to do high Cardio despite my being not able to run around ½ football field. Instead he is putting me on Flecainide 100Mg twice daily. He adds he thinks my issue is PVC’s that have incidentally gone down from 36% to 25% of the time since paced, still too high burden.
Flecainide – Helps to keep heart rhythm normal by slowing down nerve pulses and reduce PVC’s. Also used for tachy and afib.
2/ After 4 consecutive days of attempting Cardio runs and failing I felt terrible and took a whole day to recover. I believe I am “hitting the wall”. I eat well before exercising so do not think this is low glucose. I do not get lactose spasms, just leg weakness. Is the pacemaker setting 130bpm causing this?
Answer: No. Slow down Andrew you are old! I will only do low Cardio commensurate with my age. I reported to him I still do all exercises, but not high intensity. Actually I don’t really like high intensity Cardio, just got into this habit.
3/ Could you please confirm whether I have Chronotropic Incompetence? This definition describes my recent cardio intolerance well. Ref collapsing after ½ jog around a football pitch. Also before Pacemaker last summer “Exhaustion story summer 2023” and recent “Exercise log”.
Answer: Tim and EP did not like the expression; he uses the word: “Inefficiency”. Easier to understand. Recommended I walk around the soccer field.
4/ Do I have Sick Sinus Syndrome OR Heart Block OR both? Is everything else OK?
Answer: See 1/ I had the first recorded event of Afib. New issue.
5/ My body demands and chooses the % pacing in the Atrium and Ventricular chambers. I see the graph on page 12 shows a 24-Hour period Aorta paced dramatically 12% to 99% while Ventricle hardly at all. Does the excessive Atrium readings mean I have a Sick Sinus?
Answer See 1/ Yes, most issues in the Atrium and tied to Sick Sinus. Agreed with this statement.
6/ My Rate Response included in CLS mode is “Medium”. I seem to have a lag and have to take more deep breaths than usual. If this was increased would it solve my maxed-out exhaustion issue? OR should my upper rate limit of 130bpm be increased?
Answer: He seemed to think my settings were OK. No Change, Try Flecainide for two months (until Feb.) I asked if this medication could be forever, and he said “YES” if it works. He will try CLS changes if I improve with medication. I notice some caution re Driving- Check this out.
7/ What is Rate Adaptive Pacing? Is it the same as my Rate Response.
Answer: Yes. Tim said another expression was Rate Profile Options. Settings to speed up response.
CHIT CHAT (If time permits)
I am awakening much more refreshed these days, I think the resting rate 60bpm is giving me more oxygen during sleep. Agreed OK
I do not like the sound of an ablation or meds. If possible can we fix my lackluster and cardio intolerance with the Pacemaker? No Chat, I will take Flecainide.
Sheila and I had a Thanksgiving trip to a wonderful Lodge in Yosemite National Park, booked up before I was paced. This turned out to be 5,800Ft (Same as Denver CO). I immediately got short winded just pushing the suitcases and opening our room door was an effort. It got better on the third day. I am better now.
Answer: Said Pacemaker was set and working OK. These are old issues exacerbated by having it. The fix is Flecainide or other for now.
Other Comments from Tim:
I have No A/V Block above 130bpm. Good for my age
I have no H’Block under 60 to 120 bpm. Also good for my age
Above 60bpm the Pacemaker is driving my Rate
No apple watch etc, will read correctly. I will never go below 60bpm- period. Try Target Fitbit maybe, return if need.
All my Settings are within in CLS. CLS is turned on
He explained my Pacemaker CLS will read what is required and there is NO memory. It senses by the milli-second. This is where the word Adaptive comes from. (Buzz word).
I asked re – Cardio therapy, he commented I had not had heart surgery, and they are taking care of me. I can see them any time. Sounds very good.
I had the first recorded event of Afib, this was while at altitude 5,800 Ft, Thanksgiving trip.
7 Comments
Very good report!
by Lavender - 2023-12-12 19:24:29
You remind me of....me🤣
I keep notes in my iphone and add to them when any questions come to mind that I want to ask the Doctor, cardiologist, whomever.
When I am ready to see them, I trim the list and condense it.
As soon as I leave, while in the car, I write the responses they give me so that I can review them.
Your team sounds very patient and accommodating! Hoping it put your mind at ease!
Wel done
by piglet22 - 2023-12-13 05:44:01
Good to hear that you were able to discuss all those items and write them up here.
With the pressures on health services, it's becoming increasingly difficult to talk to anyone.
My health trust (UK) has cut things to the bone and you could measure the time between conversations in years..
I haven't looked at your bio, but I have noticed a real drop off in fitness in the last year or so.
I walk every day and have clocked up just under 4 million steps and over 1700 miles this year, but the stops are more frequent especially going uphill, and it's the legs that suffer.
I don't seem to be able to get my heatrate above 80 BPM.
Age is certainly a factor and despite the fact that it gets more uncomfortable, I will continue as long as possible.
Maintaining a good level of fitness helps you through the bad times.
Primary care support for this is non -existent. Yes, there are lots of private facilities for Pilates and all that and dare I say popular with the ladies.
For blokes of a certain age, there isn't much doing.
What clinics there were closed down years ago.
Neglect comes to mind.
If it wasn't for the support of this club, things would be grim.
Thank you for the update
by Gemita - 2023-12-13 05:52:29
Andrew, It sounds as though the AF occurred due to high altitude. Perhaps it was a one off? You seem to be very confident in your team and this is reassuring.
Good choice anti arrhythmic Flecainide. It is generally a safe medication, although not recommended for patients with coronary artery disease, left ventricular dysfunction, or significant structural heart disease. I was on it for 3+ years and it is usually well tolerated and an excellent starter medication for many of us although it can, like all meds, have some side affects. I got some blurred vision initially while on 2 x 50 mg daily (usual starter dose) which I thought was due to my cataracts!
Do you mean Atrial pacing, not Aorta? (Question 5). I am glad you are mainly atrial paced with a low % pacing in the ventricles. That sounds excellent. Same here.
I laughed when I read Tim and your EP didn’t like expression Incompetence, preferring “inefficiency” which is easier to understand. I am all for making these things easier to understand. This is such a vast technical area that I am struggling to keep up with and we need to try to simplify things, don’t we.
So you have Sick Sinus Syndrome with daily PVCs. The latter can really affect cardiac function as many of us here have discovered. Flecainide can help with PVCs and other arrhythmias, including AF, but raising our lower rate limit may also help, particularly with the ectopics. Mine was raised from 60 bpm to 70 bpm and this effectively helps to overdrive pace my slower, irregular heart rhythms.
Thankyou Piglet22,
by ANDREW75 - 2023-12-13 15:07:28
Thankyou Piglet22,
I originally came from the UK, and keep in touch with my sister–in-law. The differences between the two countries is startling.
Our gym is full of old men and women, we outnumber the young. This is partly because most Health Organizations offer free membership for over 65 as an incentive. This is a huge saving of about $750 a year, quite substantial. Medicare cover my wife and I go to the fully equipped gym and we both swim three times a week. In the summer we travel California chasing the wind so I can windsurf.
Compared to other sites this is a very classy environment and I feel comfortable and safe posting here.
Thanks
Thank you Gemita,
by ANDREW75 - 2023-12-13 17:03:20
Thank you Gemita,
Yes my one and only new Afib was at high altitude, I think it could be random and not connected. It’s reassuring to know I am monitored, what wonderful software to be able to decipher the different issues after all the many years of development.
I fixed the post to read Atrium for future readers. I am an avid recorder having being an engineer. I left spaces between the Q’s to write Keywords. This method works quite well for me, and I was able to update quite easily. I usually have two files for Q’s and Answers.
When I first saw the word “Chronotropic – relating to the timing of the heart.“ I misread it as Chronic, I eventually had to look it up.
Most of the time with was with Tim the Tech, he answered most of my questions, it was quite intense for a while, He loaded my memory stick with the new Interrogation. My Brady Cardia has been checked at low setting of 60bpm. When my EP came in he said he wants to do one change at a time, so for the PVC’s I’ll be on a Flecainide trial for 12 weeks or so, and perhaps longer.
I came across a photo of you and your husband, you both look very happy for people with heart issues.
Andrew
You know you're wired when...
You need to be re-booted each morning.
Member Quotes
I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.
you are happy
by new to pace.... - 2023-12-12 15:38:28
glad to read you finally got your answers.
new to pace