Pacemaker Mediated Tachycardia

I understand your frustrations

by Gemita - 2024-09-03 10:49:46

Old Rocker, I see you had an AV Node ablation.  Unlikely but AV Node ablations can, rarely, fail so that is one thought and your atrial tachycardias may still intermittently be finding a way through your AV Node to push your ventricles too fast.

On the subject of pacemaker mediated tachycardia, unless you have a confirmed diagnosis, it is hard to know how best to help you.  If you really feel that this is your diagnosis, then with respect I would go back to your doctors and ask them plainly:  is it possible that I have pacemaker mediated tachycardia or a pacemaker mediated arrhythmia of some kind, and then see what they say.

When you know what you are facing, we can try to help.  They may need to offer you external holter monitoring to try to confirm what is going on.  Even though we have a pacemaker, it only records or stores what our doctors ask to see, so some disturbances will not be picked up.

The fact that you are having severe symptoms needs to be brought to your doctor's attention as soon as possible, since clearly you need help.

Fixing any arrhythmia, even a pacemaker related one, is not always an easy fix, like turning something on and off and it may involve several different settings, which is why you need to go back to your doctors.  Are you on any meds to slow the heart rate?

Tachyarrythmias

by Xtrabeat - 2024-09-04 08:45:26

I have had PMT and had the settings in my device changed to try to stop them - referred to as "atrial blanking" in my case (different to PVARP). They are often caused by retrograde VA condiuction (which can be seen on an ECG if you catch it at the time) or may be due to increased sensitivity settings or somehow related to the rate response if you have that turned on.. Usually they occur at about the maximum tracking rate.

The PM is able to record and store them for future interrogation (again needs to enabled). Exactly what is possible with your PM depends on the model but I think they are all pretty similar - at least for newish devices - I note yours in about a year old. I think you need to report this to your clinic and if nothing obvious on PM interrogation then see if they wil do a prolonged ambulatory ECG monitor. Paradoxically (and inevitably) when I had mine nothing happened while I ws wearing it so I have now purchased a continuous monitor (Frontier 4) and can see for myself what is happening and I can save traces to show the clinic. If this turns out to be something different such as an aberrantly conducted SVT( by-passing your AV node) you may need to take drugs to stop them, particualrly if frequent.

As an after thought I shoud add that the adjustments made to my pacemaker have limited my upper tracking rate and along with a lot other stuff has actually prevented me from doing any vigourous exercise - I am waiting to have a further discussion. 

PMT with Biotronik and CLS

by Heike - 2024-09-04 08:47:28

Which pacemaker do you have exactly? It took me about 1-3 years each time until each of my pacemakers was programmed to the best possible compromise. I had pacemaker tachycardia with Biotronik and CLS sensor (before and after AV node and HIS ablation), which was not recognized as such. If you have tachycardia, do you know how high your pulse is? With pacemaker tachycardia, the pulse is the programmed upper rate. In my case, PMT protection was programmed to ON, but the pacemaker still did not recognize my PMT as such. The technicians from Biotronik had never thought of this either. It was only when I had a Reveal implanted 3 years later that I was able to prove to my cardiologist that I really did have pacemaker syndrome with PMT.
In my case, the PMT could not be resolved by changing the settings and I had a system from Boston Scientific implanted early on.

Go back to the clinic

by Gotrhythm - 2024-09-04 14:13:44

I read your post three times because I kept feeling something was left out. To me the obvious next step is evaluation by your pacemaker team. Then I saw it. "They pacemaker clinis tells me my pacemaker is fine." My friend,  when it comes to PMT, "your pacemaker is working fine" is not an adequate answer.

PMT happens when your heart is doing something that your pacemaker's programming doesn't know how to deal with. So your pacemaker isn't wrong or malfunctioning. It is fine. It's doing exactly what it is programmed to do. But what it's programmed to do is having unfortunate consequences.

Most modern pacemakers do have automatic detection of PMT. Unfortunately, there is more than one kind of PMT, and there are not algorhythms to detect all of them. It takes a smart, savvy tech to chase down some of them.

My first thought is that you need to go back to your clinic and tell them that you are having fast heartrate spells that leave you close to syncope. Say you wonder if it's some form of PMT that the pacemaker isn't picking up, or if it's something else. I myself had PSVT which is not related to the pacemaker, and RNRVAS which is.

For more discussion of PMT and RNRVAS check out the archives. To find them go to the Q in the upper right hand corner of the header.

As you have already reasoned, any condition that leaves you close to passing out is dangerous to you and to others should you be driving at the time. So it really is important to get this tachycardia taken care of.