Do any of you know what this means

Hi
Im booked in to have my PM changed on Tues 19th Aug and recieved a letter from my cardiologist to my GP saying the following - i really dont understand any of this. I really hope some of you can lol - here goes:

To summarise, this lady has an incessent atrial tachycardia which was not amenable to ablation. She therefore, underwent dual chamber permanent pacemaker inplantation and AV nodal ablation. I understand that since then, she has had recurrent difficult to control atrial tachycardia to the degree that the pacemaker has has been set to VVI mode. By ignoring the atrium, the atrial tachycardia is not tracked by the pacemaker and so does cause her significant palpitations and tachycardia. Her current rhythm is that of atrial tachycardia approx 160 BPM with VVI pacing at 60 BPM.

I considered our potential treatment options. On balance, i feel that any upgrade of her permanent PM to a device with anti tachycardia pacing and atrial tachycardia prevention algorhythm is unlikely to benefit her. The atrial tachycardia is unlikely to be "pace terminable" as it is likely to be an automatic tachycardia arising from the pulmonarry vein region and atrial tachycardia prevention algorhythms are unlikely to work for the same reason i.e. it is an automated focus. I will therefore, arrange for her AT501 pacemaker to be replaced with a standard DDDR permanent pacmaker set to VVI R mode which will allow us to revert to dual chamber pacing should her atrial tachycardia ever come under control in the future.

I do not understand ANY of this - can any of you helpo me please????

3 Comments

what this means

by Vai - 2008-08-14 01:08:34

Its a lot to read but let me try
1. Patient has a persistent rapid heart rate in the upper heart chambers or atrium ("incessant atrial tachycardia")
2. This patient's condition (rapid atrial heart rate) is not readily helped by ablation.
3. This same condition is also not readily helped by electrical means such as a pacemaker. Even those PM with special heart rate control functions to prevent fast heart rate is unlikely to help this patient's condition.
4.Patient had AV nodal ablation which means the heart's natural electrical pathway between the upper chamber (atrium) to the lower chamber (ventricles) has been burnt-off or disconnected. Natural electrical impulses no longer pass from the atrium to the ventricle.
5. Patient has had a dual chamber PM implanted. The lead to the upper chamber is not doing anything for the patient. The upper chamber is beating rapidy at 160 beats per minute (BPM). This rapid rate is not transfered to the lower chamber due to # 4 above..
6. The lead to the lower chamber is maintaining the heart rate at 60 bpm, keeping the patient well.
7. The recommendation is to use a normal pacemaker and leave the atrium alone while using it only to maintain a healthy heart rate in the ventricles.
8. At some time in the future, the upper heart rate may go away on its own or becomes controllable, then the upper lead will be put into use at that time.

I know this is not a technical explanation of every term in the letter. But I felt keeping to the essentials will help you understand your condition. You can learn about each of the terms later once you get the big picture.

I hope this helps.

Good luck.

Technical issues with pm

by Fluzy Suzy - 2008-08-15 05:08:08

Hi
I have had my pm since 1986 and I am still very very
innocent of the technical sides of pacemakers. If I go and ask my cardiologist technicians, they look at me as if I was from another planet and should not be asking any questions at all.
Best of luck to anyone who can receive substantial answers to the questions they have or going to ask
I live in the U.K. if that is saying anything.

Fluzy suzy

I'll try

by ElectricFrank - 2008-08-15 12:08:27

Val gave a good explanation so I will try to just cover the bottom line in different terms.

As I read it you have a fast atrial beat of 160BPM which doesn't seem to be controllable. They have done an AV node ablation which keeps the fast atrial beat from pacing the ventricles at the high rate. (You can live with 160BPM in the atrium, it would be risky to let your ventricles follow it.)
With the AV node cut they installed a pacemaker to pace the ventricles. In VVI mode it is set to a fixed rate of 60BPM.

So from your perspective your heart is somewhat impaired as far as pumping efficiency is concerned. The two chambers aren't synchronized as in a normal heart, and your heart rate doesn't respond to exercise. As far as the last is concerned I wonder why they aren't trying VVIR mode which adds rate response to activity in setting the HR.

From your description though it sounds like the approach is well thought out. This is one of those times when our little electronic friend can make a big difference.

I wish you the best,

frank

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