Protocol for pacing change - UK

Does anyone know whether a protocol exisits for a Pacing Technician making major changes to a patients pacemaker progam (as opposed to slight adjustments / routine checks), without reference to the patients Cardiologist / Electrophysiologist?

7 Comments

Reply to Ian

by Dave Bishopstone - 2014-06-28 01:06:43

Hi Ian, I had atypical atrial flutter diagnosed in 2000 and have an unsuccessful ablation. A permanent pacemaker was inserted and with a very low dose beta blocker daily had 8 years problem free. Then came pacemaker change No1, after which atypical flutter came back on the scene. Quite a few cardioversions, electrical and drug. Then went on 'pill in the pocket' regime with Flecainide. Quite successful for a while then more episodes and more Cardioversions. This led onto two further catheter ablations, the last in Dec 2012 was, I'm told successful. Pacemaker remained in place permanently pacing between 70 and 120 bpm - all going well no events until June this year when battery life of pacemaker 2 depleting so put on more regular checks. For a reason best known to the Technician she detected my own heart rhythm was good - so without consultation she moved the pacing from permanent to a state where it would only pace if the rate fell to 60 bpm - in effect practically idle. Two days after the change, guess what, irregular rhythms occurring. Few return visits and original settings restored but has not solved rhythm problems - another visit due in a couple of days, I had contacted my EP/ Cardiologist and updated him on events and he has arranged the forthcoming visit to look at the settings again. One of the leads has always been what is described as 'noisy' and detecting the 'p' wave is sometimes difficult, but when inserted it was the best signal that could be received where it was placed. I am just wondering if they have adjusted the settings upwards to detect the 'p' waves and in effect the Pacemaker is now over-sensing and causing problems. Presently listed for pacemaker No.3. I think my point is with Pacing Technicians is that they know the equipment OK, but do not know the patients quire so well. I've always had the same EP/Cardiologist (great guy), however I always see different technicians. There is a saying, 'If it ain't broke, it don't need fixing!'

EP

by APgirl - 2014-06-28 05:06:30

I am also in the uk and have a conversation with the EP who makes no changes without discussion. I always ask for a printout and discuss any issues.

Advice from a wise soul called Electric frank has put me in the driving seat, ie. before you tune my engine, here's what I need it to do and this is my lifestyle has worked.

Question, question and question until you are satisfied any tweaks will have the desired effects.

Cheers
ap

Hi Dave

by IAN MC - 2014-06-28 09:06:01

I don't know the answer to your question as to whether there is a laid down protocol or not; I guess it will vary from hospital to hospital.

Compared to some other countries , in the UK, the 'Pacing Technicians " , or Cardiac Physiologists to give them their correct title are extremely well qualified and are respected members of the cardiology team

They all have B.Sc 's in Heatth care Science, specialising in Cardiac Physiology. So they are intensively trained in the recording and analysis of any data to assist in the diagnosis and treatment of heart disease. They have received far more training in cardiology than has the average doctor !

They spent 3 years of their lives at University learning about their speciality as well as all their on-job training with patients. They are of course trained on every make of pacemaker ( which the doctors aren't ! )

They probably know far more about pacemakers and their adjustments than do the cardiologists and E.P.'s.

In my local hospital, the Cardiac Physiologists have regular meetings with the doctors to discuss individual patients but most of the time they are totally autonomous and make all of the decisions regarding pacemaker adjustments.

I know that in the US , PM manufacturers' reps are used to adjust PMs . Posts on here would indicate that the individual variations in competence are massive. Our system is better !

I am intrigued by your question. What do you mean by "major changes " ?

Ian

My Experience

by Many Blessings - 2014-06-28 11:06:58

I haven't had any PM changes for a while, but when they were experimenting trying to get things right or trying to make improvements, my PM Tech made the changes and told my cardiac doctor later. After about a year after my CRT, my PM Tech made/makes suggestions and I get to call the shots as far as adjustments.

Like Ian said, your PM Tech, Cardio doc, and EP doc are a team. For my team, they all trust each other's decisions, meet or talk on a regular basis, and most of all, ask me how I'm feeling and what works best for me.

It could be a lot different from country to country, state to state, or doctor to doctor, so I can't say what is normal protocol for anyone else, but that's how mine works.

My advice is to learn as much as you can, ask as many questions as you can to your cardiac team and this site, so you can be well informed. Stay involved with your treatment and cardiac team. I don't do well with setting changes and don't have them anymore since things are going well, but I still watch my tech like a hawk during my CRT interrogation so no changes are made by mistake. LOL!





I agree with APgirl 100 %

by IAN MC - 2014-06-29 07:06:27


You said it all, Dave, when you said " If it ain't broke, don't fix it " but to achieve this you have to tell the tech before they ever connect you up that i) you are happy with your settings and ii) you don't need any changes.

I , too, always get a printout and compare it to the previous one to make sure that no sneaky changes have been made. Some people on here have had problems getting a printout from our good old NHS, but I have never had any problem myself ; it is all about building up a good relationship with your " Cardiac physiologist" or "tech"

I used to see a different tech every time, but now when I make an appt I insist that I only see Mr X who I rate very highly. As APgirl says you have to be in the driving seat, it is your health at stake, and it is your body !

It is difficult to explain your situation where they reverted to your original settings and yet you still had problems. I guess it is possible that it was co-incidental and the PM settings weren't the cause, or had they in fact made some small settings changes which they didn't tell you about.

Best of luck with your next visit and let us know how you get on

Ian

Me Too

by Many Blessings - 2014-06-29 12:06:12

I forgot to mention, I get a print out too. And, there is always a print out made for my cardiac doctor and EP doctor to put in my files.

Once my settings were set right and I felt good, I didn't (and don't) want anything changed. And, if there ever is a question, it's right there in print for any of them to look at.

My PM Tech comes to my cardiac doctor's office to do interrogations so his file for me is right there with her while she's doing it.

I'm with Ian on maybe there was a small change made that they didn't tell you about. That happened to me before (hence the NO changes are now made without my knowledge). It was a voltage change, which shouldn't have made a difference, but it did. After she changed it back, the symptoms went away. She tried it again just to see, and they symptoms returned.

Ask if ANY adjustments were made when you first noticed it to see what they can come up with. If it was changed in any way, ask for it to be changed back. Even if it's something that "shouldn't" cause a change in how you feel, it sometimes can.

Update

by Dave Bishopstone - 2014-06-30 03:06:35

Attended pacing clinic today, Consultant EP/Cardiologist was in attendance (as I said previously a really great guy who knows his stuff) and had good discussion of what had been going on, symptoms etc. He looked at the readings taken over recent weeks and arranged for new ones taken there and then. He noted the heart was being paced 'inappropriately' on occasions. It was put down to one of the leads not picking up information leading the implanted pacemaker to conflict with my own natural pacemaker. After trying various settings he noted that my own hearts pacemaker was producing the best readings. (recalling a successful ablation for atypical atrial flutter in Dec 2012). The change in settings on 5th June last had obviously triggered a further defect on the lead. We decided to render the implanted pacemaker virtually inoperative by lowering the settings as far down as they would go and allow the heart to function unaided. It was noted I was getting a few 'ectopic' beats (with or without artificial pacing) which may settle down. Up for review in a weeks time - keeping fingers crossed.

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