ICD Review

I saw my cardiologist last week who did an ECG and said I was in AF and I should have the Rate Response turned off and put on the list for an AV Node ablation (see my post 18th June AV node ablation). This week I had my ICD review. The ECG and the device historic data said I was only in AF once in the last three months and not last week. This is not what the cardiologist had said. The EP doing the review said I was experiencing tachy-brady. This would explain my heart rate frequently going from 55 to 100. I was told that they would adjust the RR but not turn it off. They did lots of tests and made various alterations to the ICD programming. I must say I couldn’t understand a lot of the jargon the two ladies were discussing. They took the time to answer all the questions on the list I had brought with me. I was sent for a brisk walk around the hospital and further adjustments were made to the ICD.  She said she would discuss my case with my cardiologist at the next group meeting and was not convinced that an ablation was what I need. An appointment was made for three months time and I was given a phone number for the clinic if things are not good and they would get me in sooner for further tests and adjustments. I must say the staff at Derriford Hospital in Plymouth were excellent as usual.

In the meantime I have been feeling well and my heart rate consistently at 55. Fingers crossed it stays this way. I thought I would share this with you all.

4 Comments

Thanks

by piglet22 - 2024-06-29 07:22:15

It's good to hear fellow UK experiences.

There are bound to be some differences in interpretation, but by the sounds of it, you are getting good care.

The more you hear about tweaking settings, the more you realise just how complex these devices are. Just accessing the settings and data is a considerable technological achievement.

I do a bit of coding and know how difficult it is.

I have a "virtual device" clinic in two weeks time as the battery is getting low.

At one of these 3-monthly checks, I'm going to get the call to make an appointment for the 9-year major service. On 100% paced, not really looking forward to it.

Long may AF stay quiet

by Gemita - 2024-06-29 07:48:53

Graham, 

It is a funny thing but when we are in AF, we just want it to stop because it makes us feel so awful, but when we are in normal sinus rhythm, we wonder what all the fuss is about.  

I can see how difficult it is for our doctors to make the best decision on what to do when we can swing from one extreme to the other in a matter of minutes, especially with tachycardia/bradycardia syndrome.  For some of us we tolerate AF so poorly and will do anything to stop it, even if AF only occurs intermittently/infrequently.  For others, who tolerate AF well, they would only proceed to such a final stage (AV Node ablation) when their symptoms deteriorate to such an extent where no other treatments are available to offer respite.  I don’t think either of us have reached this stage quite yet, have we Graham?  But it is a difficult call.

It sounds to me as though you and your team have made the right decision, at least for the moment.  Thank you for sharing your positive news.  I am very happy for you since your AF is certainly not persistent from your latest reports.  I hope you continue to do well

I hope this explanation helps

by Gemita - 2024-06-29 09:13:29

To help explain the differences in what was found during your cardiology visit and during your recent ICD review, we should perhaps remember that an ECG tracing is a snapshot of what is happening at the time of the recording and only lasts for a minute or so, so a lot can be missed in such a short period of time.  However a surface ECG is usually very accurate, depending on operator experience and machine accuracy of course.  A surface ECG should always be confirmed by an experienced doctor, especially when a patient has a pacemaker.  I am sure AF was confirmed by your cardiologist last week after seeing your ECG.

On the other hand your ICD/pacemaker will only store and record what your pacing team/EP has set up, that is, when the parameters for the storage and recording of a significant arrhythmia have been met.  Obviously if an arrhythmia doesn’t meet these parameters, for example if you have AF at a slow or normal heart rate, not all episodes will be stored on your device.  They are usually only interested in atrial or ventricular high rate episodes/events.  And remember normal rate could be anything between 60-100 bpm and AF can easily present at lower rates like these, especially as we both take rate control medication.

So in my opinion, both the Cardiologist and the ICD clinic have given accurate advice and will both be correct with the tools used at the time.

I am glad you had such a valuable experience at the ICD review clinic and that you were listened to and had your questions answered.  It makes such a difference.  Good to hear they will be discussing your case at the next group meeting.  

Persistent AFIB

by Old male - 2024-06-29 22:42:02

I have lived the past 10 years with an ICD for Ventricular Tachycardia episodes.  Have had shock (therapy) only twice. Also, have lived with persistent AFIB over the past 2 yrs.  Fortunately, symptoms are only occasional shortness of breath. Seems to occur mostly when I stay bent over too long as in picking something off the floor or ground.  

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