Post surgery heart block going away? Might be happening to me 10 months post-op!

[camgough]

Hello,
I have searched and have not found any other threads on this. I have posted this info on other websites, so if you have read it I am sorry.
Anyways, after surgery in July I had full heart block, and 3 weeks after the valve surgery had a permanent Medtronic Adapta put in. I had a checkup in September and then againin December. At these appts had some minor setting adjustments. Then this past week I had another appt at 10months post op and the nurse commented that I was not pacemaker dependent.
Apparently when she "turned the pacemaker off" my heart was working on it's own with normal AV conduction. I couldn't believe it, and still don't really.
My mode was changed from DDD, to AAI<=>DDD. So in AAI mode the pacemaker just watches my heart, and if 2 ventricle beats are missed in a row in goes to DDD mode and paces the ventricle. The pacemaker then does conduction checks, and if conduction has returned it goes back to AAI mode. Medtronic calls this Managed Ventricle Pacing (MVP) and it is supposed to be alot more healthy for the heart in the long run.
I am wondering if anyone else has had conduction return after so long, and if anyone else is in this mode.
I am going to try and make an appt soon to see how much my own heart is conducting and how much I am pacing. Still seems to be too good to be true!

 

[Lynlw]

I'm glad to hear your heart is pacing itself now.

Justin went into complete heart block following an interventional cath and had a pacer implanted the next day during his pulmonary conduit surgery when he was 10 and he was 100% paced, in about 6 months his own heart started working completely on its own and his pacer didn't need to fire at all until he went into Complete heart block after another interventional cath. It happened a few times (he's had alot of caths and surgeries) and every time weeks or months later his own heart took over and when they did the checks they saw his pacer didn't fire at all. I don't remember what mode his was set at I know it didn't go off unless his HR dropped below the low 40s.

Hopefully this will let your battery last a very long time.

 

[epstns]

Camgough, thanks for posting this. I can't help with any real experience yet, but since my valve surgery in late February I have had a Boston Scientific Altrua pacemaker and have been pacemaker dependent. I'm hoping to get to the situation you're in, where one is less dependent upon the pacemaker and it is a safety net instead.

At my last check-up, my atrium was pacing about 47% of the time, but my ventricle was pacing 95-100% because it was pausing too long after the atrial pulse. Maybe it will improve, maybe not. I guess all I'm hoping for is long battery life and freedom to participate in the activities I want (running, etc.).

 

[heartman77]

Cam....im 11 months post op with a medtronic pacemaker....and im still 100% pacemaker dependent.......if you arent anymore thats great!!!!!

 

[Jason]

Cam, I can't weigh in on your question as I don't have a pacemaker, but I just wanted to say how great it is that you have had this development. You give hope to others!

 

[camgough]

Hey folks, thanks for all your nice responses. In the 2 weeks since my last pacemaker checkup and mode switch, my cardio training has been very inconsistent. Some days I can run/walk intervals and my HR will increase and decrease like it used to prior to the mode switch. By then end of 35-40 mins of intervals my HR usually will get to around 170 or so, with a workout avg of 140ish or so. Other days my HR will hit a number like 118, or 125 and then drop into the 70's. This reminds me of when my pacemaker used to be set to a high of 140, and when I got there it would drop my HR to the 70's.

This is quite frustrating because somedays I am fine, and other's this crap happens. It's hard to be motivated to workout if I don't know what my heart/ pacemaker is going to do.

I have an appt this Fri where I am going to do a treadmill stress test while hooked up to the pacemaker machine so they doctor's can see what is happening.

On the phone the doctor said he might have to put the setting back to DDD. I hope this is not the case since this means my ventricles would likelt be paced more than with the new AAI<=>DDD settings. I just hope the day of the test my heart does the block thing, and doesn't co-operate and let me "run like the wind", or a slow breeze more like.

Any thoughts???

 

[Greg a]

Cam , my ICD is part of the RAFT study from the Ottawa Heart Institute but I have a Carelink unit on my nightstand http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiac-rhythm/patient-management-carelink/medtronic-carelink-network-for-cardiac-device-patients/index.htm and IF I am paced or therapy is delivered it will notify my Implant Clinic and I will be informed or if my EP wants to look at what has been happening with me an interogation can be done or scheduled to be sure I am around (I have to be within six feet of it aonce a day) or if I am not feeling well I can do an interogation and have my EP call here to the house ....just one more bit of peace of mind as it is all right away and not on my next visit

 

[Elcarim]

Wow, you are lucky! After my AVR 5.5 years ago I am still 100% pacemaker dependent. I don't think mine is coming back.

 

[camgough]

Greg, That sounds very interesting. I was never offered this or have really heard about it. I see the EP in Kingston,ON Friday so I will see what has been going on with the new settings. My jog/walk yesterday was good, and today I did the Law Enforcement Torch Run for Special Olympics. It's more of a walk, but still good to get out for a good cause.

 

[AgilityDog]

Cam, your pacemaker keeps a record of what's been going on. If you know the times and dates of your work outs where you did well, and those where you had problems, you may very well find a correlation with the pacemaker firing. Or not. Even before my ICD, the tech could tell on my regular pacemaker when I was working out, and for how long (no exaggerating the exercise schedule-tattletale box!)

I have/had vtach issues and they could tell me when I was in v-tach over the last x months with my ICD - I could recall it was night and I was asleep, or sunday morning reading a book, or something else where I was going into vtach for no reason, and never felt a thing.

So I suggest writing down what you remember of your difficult workouts and you may be able to get them to see what your pacer was doing, or not doing, during that time period when they do the next interogation.

 

[Guest]

if you arent anymore thats great!!!!!

*nods*

Indeed.

I seem to be going in the OPPOSITE direction....



Cort | 37.m.IL.pigValve.pacemaker | 5 Monte Carlos + 1 Caprice Classic | * meet_10.15.11_Volo.IL *
MCs.CC + CHD.models.HO.legos.RadioShows + RoadTrips.us66 = http://www.chevyasylum.com/cort
"These times I've spent, I've realized" __ EMF __ 'Unbelievable'

 

[epstns]

Yeah, Cort - I'm in a boat similar to yours, but I'm hoping that there is still a chance that I may become less pacemaker dependent in the future. Hopefully for me, it may just be too early to tell.

 

[Guest]

I hope that is the case for you, Steve.

In mine ... not so much. Heart block in one section ... with an enlarged heart ... and a few other things going on ... *sighs*



Cort | 37.m.IL.pigValve.pacemaker | 5 Monte Carlos + 1 Caprice Classic | * RT_06.2011_us66+NW USA
MCs.CC + CHD.models.HO.legos.RadioShows + RoadTrips.us66 = http://www.chevyasylum.com/cort
"Something's wrong in the world today" __ Aerosmith __ 'Living On The Edge'

 

[camgough]

Well here is the latest........Had an appt on Friday with the pacemaker clinic. I had a stress test while hooked up to the pacemaker programmer. I had this since it seemed I was going into some sort of heart block during some workouts.

The nurse told me that since my mode was changed 2 weeks ago from DDD to AAI<=>DDD I had been in AAI mode the whole time, there were no mode switches.

For the first stress test I got my HR to about 118 then I started to block and went down to about 72. The doctor was able to capture this on the ecg strip. He looked at it and said that when my HR increases I go into heart block, but for some reason the pacemaker failed to pick this up and didn't switch to DDD.

He then put me back to DDD mode and had me get on the treadmill again. I started to walk and went for another few minutes and then he had me stop. I did not go into block, but again for some reason my heart missed a ventricle beat and the pacemaker failed to pick up on it and do anything.

The doctor said he was excited because I am not a routine case, but that he honestly was not sure what was happening and needed to call Medtronic. So as it stands I am back in DDD mode now, hoping to be back in the AAI<=>DDD mode soon. Keep your fingers crossed the company reps or engineers can figure out how to help me

Any guesses???? I have thought maybe some of the ventricle lead sensors need to be tweaked????

Cam

 

[camgough]

OK, so here is the latest news on my Adapta settings. I had a treadmill test last week with the rep and doctor to try and figure things out. I was switched back to the MVP mode (managed ventricle pacing mode, AAI<=>DDD) and at rest my heart was conducting fine. I started on the treadmill and once my HR got to around 120 or I began to block and my HR decreased to 70 or so. The Dr stopped it immediately and the doc and rep looked at the ecg print out and discussed things for several minutes.

They believe that the issue with the MVP mode is that my own natural AV delay is quite long and the pacemaker is unable to pick this up. Unfortunately in MVP mode none of the settings can be altered or changed and are set by the company engneers to benefit the majority. The problem was that during exercise when my own conduction would start to fail or block, the pacemaker did not recognize it needed to change from AAI to DDD.

I was then put in DDD mode and did another quic brisk walk and this time the pacemaker followed my HR into the 140's no problem and paced the ventricles. So the doctor and rep began discussing again how they would keep me in DDD, but reduce unneeded ventricle pacing as much as possible.

These are my new settings, that the rep suggested were quite aggressive and pushing the pacemaker capability to the limits...

MODES Initial DDD Final DDD
Mode Switch ON ON
Detection rate 210bpm 210bpm
Detection duration no delay no delay
Blanked flutter search On Off

All the rated stayed the same. Lower 50ppm, Upper tracking 200ppm, Upper sense 180ppm, ADL rate 95

Intrinstic/AV
Paced AV Initial 150ms New 300ms
Sensed AV 120ms 250ms
Search AV+ Off ON
Max increase to AV 150ms
Rate adaptive AV ON ON
Start rate 80ppm 80ppm
Stop rate 180ppm 180ppm
Maximum offset -40ms -240ms

Refractory/Blanking
PVARP Initial Auto New Auto
Minimum PVARP 250ms 180ms
PVAB 180ms 180ms
Ventricle refractory 230ms 230ms
vent pacing (after A. pace) 28ms 28ms
PMT Intervention, PVC response and ventricle safety pacing all ON.

The only other changes were in the atrial where sensitivity was taken from 0.50mV to 0.35mV ans sensing assurance was turned off. I do not even know what this is. Battery life expected 10.5 - 14 years, likelt 12.5 years left.


There are more settings on my sheet, but these are the major ones that were changed. I can always put the whole report up as a pdf if anyone is interested.

So I guess the bottom line is that these settings will allow my heart to do as much on it's own because the AV delay was increased. Also my HR should be able to get into the 180 range and only periodically block (11:10, 10:9, etc....) as opposed to a 2:1 like I experienced before.....BRUTAL! At my next appt they will be able to tell me how much I am pacing in the ventricles, and I hope it is low! I think it will be primarily when I exercise. The doctor said that my conduction may continue to get better with time, but at the moment these are the right setting. This way I will never drop a ventricle beat, even with eexrcise which was happening with the MVP mode. The Search AV+ feature continually looks for intrinstic AV conduction, times it and changes it's setting automatically to promote intrintic conduction as much as possible, but also pace the ventricle when needed. If it is pacing the ventricle it keeps cheking on conduction and stops pacing when conduction is found.

I guess this is kind of the best of both worlds for now. I should be able to exercise up to 180 before any blocks, and pace on my own as much as possible at rest.

I also did notice on the Sorin website their SafeR pacving mode (like MVP) says that it switched to DDD quickly in exercise, but also extends the AV during rest to promote intrinstic conduction. Anyone have these settings?

Any comments on the new numbers, thoughts or similar experiences gladly welcome. Sorry for the long post!

 

[epstns]

Wow, Cam, you have really gotten them to work with you!

I'm still too early in recovery to get their attention about pacer settings. Mine is still set to a min of 60, max of 130 BPM -- and I don't know the other settings, but I'd bet they are set for the generic default settings. So far, at 14-15 weeks post-op, I can only get my HR up to about 120, so I'm not hitting the maximum. I suspect that I'm being held back by the combo of the healing/remodeling of my heart and the 100 mg of metoprolol (extended release) I'm prescribed daily. I know I'll eventually have to have a discussion with my cardio about the beta blocker and my athletic interests, but I've agreed to wait a couple of months before I do that, to ensure that everything has healed properly. (And only then will we know how complete my post-op heart block may be.)

Thanks for posting, and I am interested in how it works for you. I may need to bring copies of these threads to show my EP and cardio.

 

[Eva]

Cam, I cannot offer any advice but I shall keep you in my thoughts and prayers :angel: