Right Ventricle pacing triggering RR to go to max

It's frustrating I know, but it is still early days

by Gemita - 2024-10-17 04:26:21

CrocG, I see you had a Medtronic pacemaker fitted 1 month ago and going in for a 2nd EP appointment today, 17th October.  I hope the consultation provides useful feedback, although I see you are losing confidence fast in your team and searching online for clues for your symptoms.  Would you care to post the link about feedback between leads that you believe may be contributing to your difficulties?  I am not sure that self diagnosis at this early stage will help.

At four weeks you are still healing and your heart is settling down and getting used to being paced.  Our lead voltage is usually set higher at the start of pacing while leads are bedding in to heart tissue and this won’t be helping.  Some of us can feel uncomfortable with a higher lead voltage at the start of pacing and experience different sensations as well as noticing intermittent sudden increases in heart rate during exercise or at rest.  I know I did.  Until around 3 months, my doctors were not prepared to fine tune my pacemaker settings for exercise, or to turn down lead voltage, although they did treat my intermittent high heart rates with a beta blocker to calm things down.  

I have arrhythmias;  tachycardia/bradycardia syndrome (part of sinus node dysfunction) and some right bundle branch block.  With any arrhythmia, getting our settings adjusted can be even more difficult and requires patience.  I have tried unsuccessfully to get my Rate Response (RR) settings adjusted to suit my exercise requirements.  So far having RR on has always resulted in an increase in atrial tachy arrhythmias.  

Getting RR settings optimised can be exceedingly difficult and certainly won’t happen overnight especially if you have rhythm disturbances.  This part of your pacemaker journey cannot be rushed and it can take considerably longer than 4 weeks to find a level of pacing that feels comfortable and just right for you.

My solution was not to go rushing in with a sledgehammer but to wait patiently for a few months to see if things settled on their own, without intervention, particularly once lead voltage can safely be turned down.  

In the next few days I will send you a private message giving you details of a Medtronic member who has considerable experience working with his settings, particularly Rate Response ADL settings, to see if this might help you.

If you ever want to post any pics to the forum, you should try to upload to the Gallery, where we can all view them?

Minimum 6-10 weeks for lead to bed-in

by Rch - 2024-10-17 19:12:07

Hi CrockG. you just had the PM implanted a month ago, and it is a bit too early to realize the functionality that was intended at implant. If you are concerned about lead malfunction, an alert would have been transmitted from your home unit to your device clinic. If not, when you go to your next appoinrment, the device tech will check lead mesurements. I had also very similar symptoms and tachycardias the first few weeks after implant, and after some tweeks , my symptoms largely improved. Nonetheless, off and on, I still experience wierd symptoms . I try to catch them om my Kardia and try to make sense as to what might be happening. .So, in your case, I would suggest to wait for a few more weeks, and go easy on exercise in the interim until your next appoinrment. If symptoms fail to resolve and your providers do not have a reasonable explanation for your symptoms, then you might consider a second opionion.  We wish you well.