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Medical Forum / General / Cardiology / March 2006"Pacemaker beats" in EKG Holter report
I am an intermittent afibber and wear dual-chamber pacemaker. I had a Holter 24-hour EKG monitoring done last week. Reading the holter report, I understand that during the last part of that procedure I had an 8-hours afib episode. In the "Final Table" of the holter report I see various columns, including one named "Pacemaker beats - Ventricular" with the following hourly data: 3, 3, 1, 1, 0, 0, 0, 0, 0, 2, 11, 11, 0, 0, 0, 1, 1098, 286, 414, 409, 377, 310, 911, 579. The high-values portion of that series is actually coincident with the afib episode detection. The final comment of the holter report mentions "atrial fibrillation" and "ectopic ventricular beats". I have an EP visit scheduled next week. In the meantime, can someone explain the meaning, as well as the likely interpretation, of the data listed under the above "Pacemaker beats - Ventricular" column? Thank you > I am an intermittent afibber and wear dual-chamber pacemaker. > > I had a Holter 24-hour EKG monitoring done last week. Most dual-chamber pacemakers have the capability of recording telemetry information and mode-switch episodes thereby obviating the need for holter-monitoring. > Reading the > holter report, I understand that during the last part of that [quoted text clipped - 12 lines] > explain the meaning, as well as the likely interpretation, of the data > listed under the above "Pacemaker beats - Ventricular" column? Would surmise that each number represents the count of wide-complex pacemaker beats during each of 25 hourly intervals. > Thank you You are welcome. All thanks and praises belong to the LORD, Whom I love with all my heart, soul, mind, and strength. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/23/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 Il 17 Mar 2006 03:28:04 -0800, "Andrew B. Chung, MD/PhD" <andrew@heartmdphd.com> ha scritto: >> I had a Holter 24-hour EKG monitoring done last week. > >Most dual-chamber pacemakers have the capability of recording telemetry >information and mode-switch episodes this is the case of my pacemaker ... >thereby obviating the need for holter-monitoring. ... however the holter monitoring, to be done some 3 months after ablation and shortly before EP evaluation, was actually prescribed to me upon hospital discharge after ablation. I understand my EP evaluation, scheduled next week, will include evaluation of either holter and pacemaker recordings. >> In the "Final Table" of the holter report I see various columns, >> including one named "Pacemaker beats - Ventricular" with the following >> hourly data: 3, 3, 1, 1, 0, 0, 0, 0, 0, 2, 11, 11, 0, 0, 0, 1, 1098, >> 286, 414, 409, 377, 310, 911, 579. >> The high-values portion of that series is actually coincident with the >> afib episode detection. >Would surmise that each number represents the count of wide-complex >pacemaker beats during each of 25 hourly intervals. I'd like to know if you would consider 300 to 1100 pacemaker ventricular beats per hour as "normal" during the afib hours. Thank you --- Uplbet sorry for the "Roby1" in my initial post, I was simply fiddling with my newsreader settings :-( Regards --- Uplbet > Il 17 Mar 2006 03:28:04 -0800, "Andrew B. Chung, MD/PhD" > <andrew@heartmdphd.com> ha scritto: [quoted text clipped - 13 lines] > I understand my EP evaluation, scheduled next week, will include > evaluation of either holter and pacemaker recordings. It does not hurt to have more data especially post-ablation in the setting of a complicated EP history where the continued success of the ablation needs to be proven. > >> In the "Final Table" of the holter report I see various columns, > >> including one named "Pacemaker beats - Ventricular" with the following [quoted text clipped - 8 lines] > I'd like to know if you would consider 300 to 1100 pacemaker > ventricular beats per hour as "normal" during the afib hours. There is no such thing as a "normal" number of pacemaker beats during atrial fibrillation in a non-AV-ablated individual. In your particular case being after ablation, all ventricular beats should be pacemaker generated so that if you were set at 60 bpm, the "normal" number should be 3600 pacemaker generated ventricular beats without variability unless the pacemaker is set to increase rate with activity. For a non-AV-ablated person he expected range is from 0 (rapid ventricular response not needing the pacemaker) to the set rate multiplied by 60 (bradycardiac ventricular response far below set pacemaker rate). > Thank you You are welcome. All thanks and praises belong to the LORD, Whom I love with all my heart, soul, mind, and strength. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, cooking and nutrition that interest those following this thread here during the next on-line chat (03/23/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 > Uplbet Hi Andrew, I got your reply "loud and clear". I believe you are a _great_ resource for this newsgroup! Thank you so much and best regards. --- Uplbet > Hi Andrew, > I got your reply "loud and clear". > I believe you are a _great_ resource for this newsgroup! > Thank you so much and best regards. > --- > Uplbet You are welcome :-) All thanks and praises belong to the LORD Who is the source of all knowledge and wisdom that HE has given to all of us and Whom I love with all my heart, soul, mind and strength. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/23/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 >> I am an intermittent afibber and wear dual-chamber pacemaker. Here Chung, taste this Kool Aid.... >> I am an intermittent afibber and wear dual-chamber pacemaker. >> I had a Holter 24-hour EKG monitoring done last week. > > Most dual-chamber pacemakers have the capability of recording > telemetry information and mode-switch episodes thereby obviating the > need for holter-monitoring. Though current generation pacemakers provide some telemetry information, it is still fairly limited. I do not find that the pacemaker data provides a complete arrhythmia record and I still frequently use Holters in addition to device interrogation for my pacer and ICD patients. >> Reading the >> holter report, I understand that during the last part of that [quoted text clipped - 15 lines] > Would surmise that each number represents the count of wide-complex > pacemaker beats during each of 25 hourly intervals. Yes, but distinguished from PVCs by the presence of a pacer spike. The Holter software takes a stab at categorizing these, which is further refined by the tech who scans the data. During the AF episode, the device likely mode-switched and ended up pacing more often, up to 1098 times per hour. But for someone who is paced at a rate of 60/min, there would be 3600 paced beats per hour, just to put it in context. - TC, md Pediatric cardiology, pacing & electrophysiology Il 19 Mar 2006 08:26:19 +0100, "Terrence Chun, MD" <REtchMOVEun2THE47CAPS@comcast.net> ha scritto: >>> In the "Final Table" of the holter report I see various columns, >>> including one named "Pacemaker beats - Ventricular" with the >>> following hourly data: 3, 3, 1, 1, 0, 0, 0, 0, 0, 2, 11, 11, 0, 0, 0, >>> 1, 1098, 286, 414, 409, 377, 310, 911, 579. >>> The high-values portion of that series is actually coincident with >>> the afib episode detection. >[...] >During the AF episode, the device likely mode-switched and ended up >pacing more often, up to 1098 times per hour. But for someone who is >paced at a rate of 60/min, there would be 3600 paced beats per hour, >just to put it in context. I see. My pacer is set at 55/min by day and 50/min by night, which seems too low to me, I'll ask explanation to my EP. By the way, I am somewhat surprised by the very few pacer beats per hour - either atrial and ventricular beats - during normal sinus rhythm hours: that means I was not pacemaker dependent in those hours, correct? Thank you --- Uplbet > Il 19 Mar 2006 08:26:19 +0100, "Terrence Chun, MD" > <REtchMOVEun2THE47CAPS@comcast.net> ha scritto: [quoted text clipped - 19 lines] > rhythm hours: that means I was not pacemaker dependent in those hours, > correct? Doesn't sound like you use the pacer much during those other times. For someone who has at least a partially functional sinus node and atrioventricular node, it is always best to let it do it's thing naturally and only pace when necessary. - TC, md Pediatric cardiology, pacing & electrophysiology |
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