Turning off Ventricular Lead

Hello everyone,
Just seem to be running into some kind of block when exercising. This has happened when I swim, run, walk uphill., and on a stress test. Feelings of skipped beats, pauses, and what appears to be the heart working much "harder" Doctor. At Cleveland Clinic had my Ventricular Lead turned off before the stress test and I was successful with 135+ bpm....but high blood pressure 230/130 at the end.. Two days later on a treadmill felt the Pauses and skips all over again. Resting Heart Rate calm with few PVC'S. And b/p back to normal...

The Tech seemed confused about turning off the lead, and looking at the report it appears almost all settings are Off, with the mode set at AAI......the other settings include lower rate 60 ADL Rate 80..Atrial Refractory 400ms...Atrial Blanking 180 ms. The Rate Response still shows up but Optimization is off. Amplitude increased to 2.000 from 1.500V. Lastly, detection duration went from no delay to 5seconds and termination beats went to 5...

AV Conduction appears to be good...Have a Medtronic Adapta Duel Lead PM for SSS..... Should I be nervous about the. "Pauses" and the Ventricular Lead being turned off, or is it possible there is some blockage?

Any and All thoughts will be appreciated!!

Phil

5 Comments

Pauses

by golden_snitch - 2014-07-11 02:07:08

Hi!

PVCs are usually followed by a so called compensatory pause, so that's why you might be feeling some short pauses or skipped beats.

With SSS you should not need the ventricular lead. Your AV-node is perfectly able to do the job, and activating the ventricular lead will probably just lead to being paced in the ventricle, when not needed.

An atrial refractory period of 400ms (normal is something around 150-175ms) indicates that you might have had a problem with ventricular far-field sensing. I have had that when I had an atrial pacemaker only. It sensed some kind electrical event in the ventricles, and interpreted this wrongly. I think, the atrial lead "thought" that what it had seen was an atrial intrinsic stimulus. Therefore, it decided that there was no need to pace, which then resulted in a skipped beat. Prolonging the atrial refractory period solves this problem, as the time in which the atrial lead is unable to sense ("see") is prolonged; any ventricular event falling into that period can not be sensed and interpreted wrongly. Sorry, I think, I didn't do a good job at explaining this, it's really a bit complicated.

Hope this helps a bit.

Inga

Glad you asked

by Gotrhythm - 2014-07-11 03:07:03

Inga has answered 2 questions for me that I didn't know enough about pacemaker settings to ask.

I'll be better prepared at the next PM interrogation.

Yes...

by golden_snitch - 2014-07-11 03:07:34

Hi!

Yes, one should be able to lower it. However, it has probably been prolonged to 400ms on purpose (far field sensing). A normal setting for the atrial refractory period is usually less than 400ms. I think 150 ms or a bit more, but not sure. I know that when they prolonged mine many years ago, it was set at 450ms, and I was told that this was exceptionally long. The problem with a long refractory period is that it influences (= reduces) the upper rate you can reach.

Inga

Makes good sense to me

by Philman - 2014-07-11 05:07:36

I'll check with Cleveland Clinic as I think you are correct.When they did a stress echo after turning off the V Lead, I had a tough time but managed to get north of 135bpm. Had to work much harder than I have in the past......Thank you soo much for input, I'll keep you posted....

-Philman

Pauses

by Philman - 2014-07-11 12:07:20

Thanks Inga for the response, Is the Atrial Refractory Period a setting that can be lowered?

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