CRT, pacing and PVCs

Posts from Jan. 1, 2018 to the present. Plus important announcements. (ICD warning sounds)

Moderator: Moderators

Post Reply
dick
Posts: 338
Joined: September 4th, 2013, 11:49 am

CRT, pacing and PVCs

Post by dick » October 9th, 2018, 8:08 pm

I had a CRT installed some 5 years ago. Everything has been good. Today during an interrogation the tech noticed a change. In the past I was being paced about 100% of the time. Now it looks like I'm being paced 90% of the time. The likely explanation so far is I am having a number of PVCs which makes the pacing un necessary and thus the lower percentage. I think technically speaking, the CRT does not squish the LV chamber if a PVC is already squishing it. On my latest interrogation report, it reads under Brady/CRT Counters > % LV Paced 98 91. (in the past it was like 99 99 which is like a 10 PERCENT drop)

Two possible solutions if we get that far; drugs or procedure. Procedure would be ablation, drugs would be the damn amiodarone. No guarantees either way.

This make sense to anyone? Suggestions on how to proceed?

User avatar
Ozchrissy
Posts: 7245
Joined: September 27th, 2008, 9:28 am
Location: Australian

Re: CRT, pacing and PVCs

Post by Ozchrissy » October 9th, 2018, 10:21 pm

Hi Dick, I also have a CRT-D and mine has always only paced 98% or there about since insertion. 12 years now, on my second. I also get heaps of PVC's, in the 1000's each interrogation.

I really don't see any issue with what is going on with you. As I said, I get 3 monthly interrogations, and I get a PVC count each time in the 1000's, 98% pacing, Interventions, and CAD's each period. Not only am I not even aware of these things in my daily life, except the full shock, but my Cardiologist does not show any concern over them either. This has been like this for years. After all this is why we have our devices, to look after us, and so far my little angel has been working overtime for years.
“I am not what happened to me, I am what I choose to become.” Carl Jung

Diagnosed with cardiomyopathy in 10/99
LBBB & VT diagnosed Feb 06
Guidant Biventricular Pacer ICD inserted Feb 06: Boston Scientific Incepta CRT-D inserted May, 2012
Oesophageal Cancer, 2012, Gall Bladder & Septicemia 2014 resulting in VFib and severe heart damage
Bare Metal Stent May, 2012 Mitral Valve replaced 2015
Meds: Entresto, Bicard, Coralan, Eurtorxsiq, Frusehexl, Spiractin, Sigmaxin, Creon, Warfarin,
Appropriate Shocks for Ventricular VFib.

dick
Posts: 338
Joined: September 4th, 2013, 11:49 am

Re: CRT, pacing and PVCs

Post by dick » October 9th, 2018, 10:46 pm

You raise a good point. I am looking now at my interrogation report (Boston Scientific) and under a section titled Brady/CRT Counters then Ventricular Counters then "Total PVCs" it lists 0 (as in zero). I would note they may have tried to explain that to me but I did not grasp it. Something to the effect the device will NOT RECORD an overlapping PVC, it will then only keep track of percent paced?

I believe the current issue/question is based on I was always paced at 99 %, but now (for some reasons) I am being paced at 90 %. How come?

User avatar
Ozchrissy
Posts: 7245
Joined: September 27th, 2008, 9:28 am
Location: Australian

Re: CRT, pacing and PVCs

Post by Ozchrissy » October 10th, 2018, 1:03 am

Sorry Dick, can't help you with that. Is it affecting how you feel. I normally will go with how changes affects my quality of life. Maybe someone on here may be able to make it clearer for you. Mine is also a Boston Scientific, and I love it. My atrium is pretty boring, no issues there.
“I am not what happened to me, I am what I choose to become.” Carl Jung

Diagnosed with cardiomyopathy in 10/99
LBBB & VT diagnosed Feb 06
Guidant Biventricular Pacer ICD inserted Feb 06: Boston Scientific Incepta CRT-D inserted May, 2012
Oesophageal Cancer, 2012, Gall Bladder & Septicemia 2014 resulting in VFib and severe heart damage
Bare Metal Stent May, 2012 Mitral Valve replaced 2015
Meds: Entresto, Bicard, Coralan, Eurtorxsiq, Frusehexl, Spiractin, Sigmaxin, Creon, Warfarin,
Appropriate Shocks for Ventricular VFib.

User avatar
4EverHopeful
Posts: 931
Joined: January 27th, 2012, 11:34 pm
Location: Knotts Island, NC USA

Re: CRT, pacing and PVCs

Post by 4EverHopeful » October 10th, 2018, 9:19 pm

Hi Dick,

I had the exact same problem back in 2012. EP wanted my unit to pace me above 93%. Couldn't get it above 88% because of interfering PVCs. My EF was also suffering. He concluded that my CRT was unable to do the resynchronization therapy it was design to do, my heart was weakening and not responding to the therapy. After much discussion, he recommended an ablation. Had it done, it lasted all of a day or two. The PVCs came back with a vengence so he prescribed Amiodarone. First a high dosage then lowering down to a 200mg per day dosage.

The Amio worked stabilizing my heart. EF went from 25% to 30-35%, enough to make me feel better. After 18 months though the Amio did damage my thyroid, I now have hypothyroidism and am on daily meds for it. After 28 months, PVCs still at a manageable level so I begged my EP to go off of the Amio. He agreed for me to try, but worried about the PVCs returning for now I was stable. It's been 3 years since stopping Amio and still stable! EF still at 30-35% and PVCs are at 7%, pacing consistant at 98%.

PVCs maybe interfering with your CRT so pacing can not rise above the 90% level...
Phyllis

God's prescription for the heart:
O LORD, You have examined my heart and know everything about me. You know when I sit
down or stand up. You know my every thought when far away. You chart the path ahead of me
and tell me where to stop and rest. Every moment You know where I am.
Psalm 139:1-3

Non-ischemic DCM 09/11
PVCs, LBBB, leaky mitral valve
St Judes CRT-D (Bubba) 02/12; (Bubba II) 09/17
EF 20% 09/11; 25% 07/12; 35% 02/16
Failed PVC Ablation 11/12
Coreg, Zestril, Asprin, Aldactone, Lasix, Zocor, Levothroid
viewtopic.php?p=87649#p87649

dick
Posts: 338
Joined: September 4th, 2013, 11:49 am

Re: CRT, pacing and PVCs

Post by dick » October 10th, 2018, 9:59 pm

Understanding PVCs appears to be a problem. I went back to my interrogation/transmission reports and as of April I was being paced at 98%. However in September my pacing was down to 92% and the other day it was down to 91%. My EP tech interrogator said they get concerned when it gets into the 85-87 % bracket. She also said it was PVCs however I'm now lost when in the same report, it lists Ventricular Counters and has recorded Total PVCs as 0 (zero)?

Are you in A-Fib? Apparently I'm in permanent A-Fib which fortunately has never been a problem. I don't seem to feel it, but they say I've had A-Fib for the last 12 years. I can't see how that relates to PVCs (pre Ventricular contractions), but thought I'd toss it out.

This tech thought doing a remote transmission in a month would yield as much info as a holter monitor. But my EP though said he felt the (right) holter monitor would indicate whether the PVCs are coming from one spot or multiple spots which the CCRT would not do. If one spot, that should be "easy" to ablate compared to multiple.

I've done amio in the past. I don't see me going down that path again. So we are all learning a little about PVCs, LV pacing reports and a new use to have a home transmission device.

InSync
Moderator
Posts: 976
Joined: July 21st, 2012, 10:26 pm
Location: The Edge of America, SC

Re: CRT, pacing and PVCs

Post by InSync » October 11th, 2018, 6:54 pm

I had something similar on a report a couple of interrogations ago. My doc and I talked about the # of ATP increasing over previous interrogation and what that could mean, then doc left. I asked tech for a copy of the report and when he printed it, there was 0 ATP events on it. While I was talking to my doc, the tech had cleared the report, so when he printed it for me, it was info since last interrogation.....which had been about 20 minutes prior. Did your tech print your report at the same time the doc's report was printed?
Dilated Cardiomyopathy, LBBB, CHF
St. Jude CRT-D 5/12
The beat goes on.....

garya
Posts: 563
Joined: September 10th, 2010, 9:04 pm

Re: CRT, pacing and PVCs

Post by garya » October 11th, 2018, 9:21 pm

Just asking, but it seems Dick is reporting numbers on say page 19 and 20. LV Pacing % on page 19 and Total PVCs on page 20. It is all the same report at the same time, but still a good question.

Post Reply