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Medical Forum / General / Cardiology / January 2006"Timed" fits?
70 y.o. male, dual-chamber pacemaker implanted since 2002, RF ablation of intermittent atrial fibrillation last month. My problem: every day at 7:15 pm plus/minus 10 minutes, while sitting, I feel a sequence of puncture-like fits coming from my heart, each fit distant 15 to 20 seconds from the previous one. Those episodes occur just once a day and last no more than two or three minutes. When I mentioned that to my cardiologist, he did not comment and did not say anything about the possible cause. However I'm concerned with that. And in addition, I'm quite surprised by the punctuality of the episodes. Would you have an explanation of those fits and their timeliness? > 70 y.o. male, dual-chamber pacemaker implanted since 2002, RF ablation > of intermittent atrial fibrillation last month. [quoted text clipped - 11 lines] > > Would you have an explanation of those fits and their timeliness? Would suggest you ask your cardiologist to refer you to consult with an electrophysiologist. Would be more than happy to "glow" and chat about this and other things like cardiology, diabetes, cooking and nutrition that interest those following this thread here during the next on-line chat (01/19/06) from 6 to 7 pm EST: http://tinyurl.com/cpayh For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/bgfqt Prayerfully in Christ's love, Andrew http://tinyurl.com/b6xwk Il Sun, 15 Jan 2006 06:54:15 -0500, "Andrew B. Chung, MD/PhD" <andrew@heartmdphd.com> ha scritto: >> Would you have an explanation of those fits and their timeliness? > >Would suggest you ask your cardiologist to refer you to consult with an >electrophysiologist. I qualified my doctor as a cardiologist, but I actually meant "electrophysiologist" and I plan to see him again next month. By the way, it now comes to my mind that after all the only "real" clock present into my body is the pacemaker. So I should reasonably deduce that my "7.15 pm syndrom" is almost certainly related to my pacemaker ... Do you agree? If so, any idea about what could be wrong with my pacemaker, or with its settings? Best regards --- Uplbet > Il Sun, 15 Jan 2006 06:54:15 -0500, "Andrew B. Chung, MD/PhD" > <andrew@heartmdphd.com> ha scritto: [quoted text clipped - 12 lines] > certainly related to my pacemaker ... > Do you agree? If it were, it should occur at **exactly** the same time every day. > If so, any idea about what could be wrong with my pacemaker, or with > its settings? Perhaps the sleep/wake modes are set incorrectly. > Best regards Thanking the LORD for your kind regards :-) It is a refreshing change :-)) Would be more than happy to "glow" and chat about this and other things like cardiology, diabetes, cooking and nutrition that interest those following this thread here during the next on-line chat (01/19/06) from 6 to 7 pm EST: http://tinyurl.com/cpayh For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/bgfqt Prayerfully in Christ's love, Andrew http://tinyurl.com/b6xwk > 70 y.o. male, dual-chamber pacemaker implanted since 2002, RF ablation > of intermittent atrial fibrillation last month. [quoted text clipped - 11 lines] > > Would you have an explanation of those fits and their timeliness? I am not a cardiologist or electrophysiologist, but I work for a large medical device company that manufacturers these devices. If this is a problem related to programming the device, perhaps I can get some helpful input. Next week (we are off on Monday - holiday) I will check with some of the electrical engineers that work as "field engineers." Oftentimes these specialists have excellent input when it comes to troubleshooting these devcies! I am sure these episodes are uncomfortable for you. Hang in there. Best, -Sue Il 15 Jan 2006 10:59:55 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: >Next week (we are off on Monday - holiday) I will check with some of >the electrical engineers that work as "field engineers." Oftentimes >these specialists have excellent input when it comes to >troubleshooting these devcies! > >I am sure these episodes are uncomfortable for you. Hang in there. dear Sue, surely I'll hang in! I assume that by "devices" you mean pacemakers, right? By the way, my pacemaker is a Medtronic KDR701 and its last control was performed last October, i.e. before the ablation procedure. Thanks so much, looking forward to get your feedback --- Uplbet > Il 15 Jan 2006 10:59:55 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: > [quoted text clipped - 15 lines] > --- > Uplbet Uplbet, I hope that I can find some helpful advice. Yes, I do mean "pacemaker" and BTW I work for Medtronic. Send me a PM with your contact information (if you wish). I may be able to see who is located in your area. And thank you Dr. Chung for pointing to the device. If this is a device-related issue, I suspect this may be an easy fix, compared to a biological problem. However I really cannot say for certain what is wrong. (I do not want to send out any unrealistic expectations either). We will have to wait and see what the experts (the electrophysiologist and the engineers) say. Best wishes, Sue > Il 15 Jan 2006 10:59:55 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: > [quoted text clipped - 15 lines] > --- > Uplbet "By the way, my pacemaker is a Medtronic KDR701 and its last control was performed last October, i.e. before the ablation procedure. " Dear Uplbet, I was thinking about what you wrote above. Although I am not the expert, it seemed to me that The Kappa should have been checked following your ablation procedure. RF ablation can "reset" the device. I am sure your physician reprogrammed your devcie following surgery, but I really think your pacer should be checked over more thoroughly, just in case the ablation procudres has affected the device eletronics. Again these are just my "lay"-opinions. I am not involved in the clinical field and I do not handle these sorts of cases, so please take these comments as non-expert. However, here is more info: http://www.medtronic.com/brady/clinician/medtronicpacing/kappacau.html "WARNINGS/PRECAUTIONS Medtronic Kappa patients should avoid sources of magnetic resonance imaging, diathermy, high sources of radiation, electrosurgical cautery, external defibrillation, lithotripsy, and radiofrequency ablation to avoid electrical reset of the device, inappropriate sensing and/or therapy." I hope to get input tomorrow from those more in the know than me. I am not credentialed to be giving out clinical advice. Best wishes. Sue Il 16 Jan 2006 07:57:34 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: >RF ablation can "reset" the device. I am sure your physician >reprogrammed your devcie following surgery, but I really think your >pacer should be checked over more thoroughly, just in case the >ablation procudres has affected the device eletronics. dear Sue, what you say makes a lot of sense, indeed! I don't recall of anything resembling a PM check procedure during or after ablation. I think I'd better get in contact as soon as possible, at least in phone contact, with my EP. Thank you! (by the way, I live near Milan, Italy) --- Uplbet > Il 16 Jan 2006 07:57:34 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: > [quoted text clipped - 14 lines] > --- > Uplbet "I think I'd better get in contact as soon as possible, at least in phone contact, with my EP." This is a good idea, IMHO. :-) I have sent out a message to some colleagues. I think the best idea is to call your EP, as Dr. Chung suggested. I hope it is a device related issue. As your know, in general, we (meaning, in the collective sense) understand how to troubleshoot devices much better than than how to troubleshoot the human body. Human physiology is much more complicated than man-made machinery. FYI. My husband and I flew into Milan 6 years ago for a honeymoon vacation. We travelled to Florence and then bicycled the Tuscany region of Italy. It is beautitful country. We drank wine, feasted on the most delightful meals. The people were so very nice. We had the grandest time. One thing I noticed in Milan is that almost every single person was walking around with a cell phone! :-) Here is what the AMA says about cellphones and pacemakers: (located at the Texas Heart Institute website) http://www.tmc.edu/thi/pacemake.html Can I use my cell phone if I have a pacemaker? The types of cell phones used in the United States are less than 3 watts and do not seem to affect pacemakers. But to be safe, you should keep your cell phone at least 6 inches away from your pacemaker. When you are talking on your cell phone, hold it on the opposite side of the body from your pacemaker. Do not carry your cell phone in your breast pocket if that means that it will be within 6 inches of your pacemaker. Newer cell phone technology means that more cell phone frequencies will need to become available. According to the AHA, some of the cell phones using these new frequencies might make pacemakers less reliable. More studies are needed before we can know how these frequencies will affect pacemakers. Best wishes, Sue (nondoctor) OOps. Typo. I meant to say AHA (American Heart Association), not AMA. -Sue (nondoctor) Il 17 Jan 2006 15:46:31 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: >FYI. My husband and I flew into Milan 6 years ago for a honeymoon >vacation. We travelled to Florence and then bicycled the Tuscany region >of Italy. It is beautitful country. We drank wine, feasted on the >most delightful meals. The people were so very nice. We had the >grandest time. happy to hear that. But ... maybe you have just been lucky ... :-) >One thing I noticed in Milan is that almost every single person was >walking around with a cell phone! :-) "one" cell only? :-)) Thanks for all the inputs, and best regards --- Uplbet > Il 17 Jan 2006 15:46:31 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: > [quoted text clipped - 14 lines] > Thanks for all the inputs, and best regards > --- > Uplbet Hello Uplbet, In regard to our stay in Italy. Yes, I am certain we are very lucky. We are lucky to have had the opportunity and the health to bicycle through Tuscany. I really hope we can do it again someday. :-) I have gotten some feedback here (and many further questions...such as whether you are pacemeker dependent, was your ablation a full nodal ablation, etc, etc.). In general we (our field clinical engineers and other experts) work with the attending physicians. So the general advice was to contact your physician and have your physican call us if s/he has questions. With that said however, we do have a Patient Services line at 800-551-5544. If you need the name of the Milan rep let me know (PM). The clinics that followup our IPGs and ICDs are listed on the Medtronic website for most large cities around the world. www.medtronic.com Best wishes to you, Sue PS There were many suggestions, all that could be checked out simply via device data collection saved to disk and then sent via email, but I do not think I should act as a go-between here. This can be done through your EP. Please let us know what your EP says. I would sincerely like to know the outcome. Thank you so much. Uplbet, Here is a more specific link: http://www.medtronic.com/corporate/commun.html Please post a progress report when you have a chance. :-) Thanks, Sue Il 20 Jan 2006 11:51:51 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: >Here is a more specific link: > >http://www.medtronic.com/corporate/commun.html > >Please post a progress report when you have a chance. :-) sure I'll do. FYI, I plan to see my EP and have my pacer checked around mid february. During that procedure, I'll put him my "fundamental" question: what does my device do every day between 7:16pm and 7:18pm ??? ... and I will not leave his office until get a solid answer ... Dear Sue, in the meantime let me thank you once more for your availability and help. Have a nice weekend! --- Uplbet > Il 20 Jan 2006 11:51:51 -0800, "Sue" <chrlie699@yahoo.com> ha scritto: > [quoted text clipped - 14 lines] > availability and help. > Have a nice weekend! > --- > Uplbet Hi Uplbet, I am glad you have an appt. If you would like a little background prior to speaking to your EP, check this out: http://www.medtronic.com/crm/kappa900/capture_mgmt.html I know this link refers to the Kappa 900, but the Kappa 700 has similar features. This explains Ventricular Autocapture Management. This is a trademark feature that checks the ventricular threshold (i.e. the minimum voltage that will evoke a cardiac pace). This allows the device to make adjustments as necessary, maximizing safety and battery life as well. This test is programmed to occur daily and lasts for about 15 minutes. The link above describes what is happening in those 15 minutes. I am not sure if this is what you are feeling at 7:10 -7:15 a.m. or not. .. but I thought you may be interested in reading about this this anyway. You have a good weekend too!, Sincerely, Sue PS If your EP has any questions, make sure s/he calls a Medtronic representative. We are more than happy to answer any and all questions. (Sorry all readers for the shameless Medtronic "plug" ... but I am hoenstly very proud to work for this company) |
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