MadelinePAC Posted June 24, 2006 Share Posted June 24, 2006 Can any of you smart Cards folks tell me about a pacer that fire "twice a day" I had a pt I was seeing for a pre-op hip. He said he had a pacemaker, he clearly had a bi-ventricular pacer present on his CXR. But the EKG showed NSR. I mentioned this to him and he said that his "firse twice a day." He had it placed 3 mos earlier for "low heart rate." Neither myself nor three IM docs I asked knew of this type specifically. Googling it just gets strange sites. Any input will be appreciated. Madeline Link to comment Share on other sites More sharing options...
MrSinn Posted June 25, 2006 Share Posted June 25, 2006 Is it a Pacemaker/ICD and "it fires twice a day" meaning he is getting shocked twice a day? Maybe I am way off.:confused: Link to comment Share on other sites More sharing options...
JenGintheED Posted June 25, 2006 Share Posted June 25, 2006 Is it a Pacemaker/ICD and "it fires twice a day" meaning he is getting shocked twice a day? Maybe I am way off.:confused: Maybe it's the sleep deprivation but that's what I read too.... pt gets shocked twice a day, whether he needs it or not... :D Hope someone can explain this one; it'll be an interesting lesson. Link to comment Share on other sites More sharing options...
coloradopa Posted June 25, 2006 Share Posted June 25, 2006 Can any of you smart Cards folks tell me about a pacer that fire "twice a day" I had a pt I was seeing for a pre-op hip. He said he had a pacemaker, he clearly had a bi-ventricular pacer present on his CXR. But the EKG showed NSR. I mentioned this to him and he said that his "firse twice a day." He had it placed 3 mos earlier for "low heart rate." Neither myself nor three IM docs I asked knew of this type specifically. Googling it just gets strange sites. Any input will be appreciated. Madeline I would bet that this is a demand pacer and that the patients HR drops about twice a day and then it takes over for a short while. Make sure this is not a defib and he is actually getting shocked twice a day. I think that would be bad (but I'm in GI - we think the heart only exists to pump blood to the abdominal organs and mimic GERD). I think the rep can interrogate the device and see whats been really going on. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
jeflesher Posted June 25, 2006 Share Posted June 25, 2006 First...there is no pacer/AICD set to do anything BID that I know of. A very brief and watered down version of device therapy. Pacers/AICDs (all AICDs having pacing functionality) predominantly monitor heart rate (you can really think of them as a set of clocks). Thereby if the rate becomes slower than a fixed level, 60 bpm for example the pacer will intervene with either an a) atrial stimulus, b) ventricular stimulus or c) both depending on the settings of the pacer and the patients underlying electrophysiology. Similarly....AICDs monitor rate and when the rate exceeds a fixed value, 150 bpm for example it intervenes with either: a) overdrive pacing (which I will not attempt to explain here), or b)cardioversion/defibrillation shock. BiVentricular pacers send ventricular stimuli to both right and left ventricles as opposed to just the right ventricle as in traditional pacers. If this patient's AICD is firing (shocking them) BID then they have real problems in that: a) Who wants to get zapped twice a day b) Their device battery's life span will be severely shortened c) They need anti-arrhythmic therapy to suppress their ventricular ectopy. -J Link to comment Share on other sites More sharing options...
coloradopa Posted June 26, 2006 Share Posted June 26, 2006 First...there is no pacer/AICD set to do anything BID that I know of. A very brief and watered down version of device therapy. Pacers/AICDs (all AICDs having pacing functionality) predominantly monitor heart rate (you can really think of them as a set of clocks). Thereby if the rate becomes slower than a fixed level, 60 bpm for example the pacer will intervene with either an a) atrial stimulus, b) ventricular stimulus or c) both depending on the settings of the pacer and the patients underlying electrophysiology. Similarly....AICDs monitor rate and when the rate exceeds a fixed value, 150 bpm for example it intervenes with either: a) overdrive pacing (which I will not attempt to explain here), or b)cardioversion/defibrillation shock. BiVentricular pacers send ventricular stimuli to both right and left ventricles as opposed to just the right ventricle as in traditional pacers. If this patient's AICD is firing (shocking them) BID then they have real problems in that: a) Who wants to get zapped twice a day b) Their device battery's life span will be severely shortened c) They need anti-arrhythmic therapy to suppress their ventricular ectopy. -J Maybe its some odd cardiology toture device that reminds people to send in their bill. Like when anesthesia uses a longer acting paralyitic and when the patient wakes up you find you are pacing the diaphragm.:D Link to comment Share on other sites More sharing options...
andersenpa Posted June 26, 2006 Share Posted June 26, 2006 Have to think this guy means that he roughly needs pacing/defib twice per day. If its shockinh him, then agree w/ above- needs more amiodarone (or the like) if it's pacing- pacing @ night? Nocturnal bradycardia? OSA? Too much metoprolol? No such thing as a "scheduled" pacer/ICD...... Link to comment Share on other sites More sharing options...
MadelinePAC Posted June 27, 2006 Author Share Posted June 27, 2006 This was not an AICD There is no shocking or firing, I took it as it turns on twice a day. So is an on -demad pacer what it is and in in his case it usually paces about twice daily then? Again this was not an AICD. I know what a AICD looks like Link to comment Share on other sites More sharing options...
jeflesher Posted June 27, 2006 Share Posted June 27, 2006 Well the only way the patient would know if his pacer was pacing him on average twice daily would have been for the nurse/technician to have told them that during a pacemaker interogation. If you are only paced twice a day then the patient obviously is not very pacer dependant. This would be rather odd, most patients require pacing at least 10% of the time. Again, the pacemaker is 'on' all the time but it will only send pacing stimuli based on set parameters. -J Link to comment Share on other sites More sharing options...
EP-PA Posted June 13, 2011 Share Posted June 13, 2011 I'm sure this is all figured out, but I just want to show I'm smart too - just kidding. In case anyone else is curious, there are a few things to consider: 1. Some folks CAN definitely feel pacing (prodominantly RV pacing). People are very different - some of my patients know if I change one bet; others I can pace up to 140 ppm or drop to 30 ppm and are None the wiser. 2. We don't see it as much, now; but several years back, many of my St Jude patients would feel the autothreshold testing that the pacemaker would go through 1 or 2 x per day. The back-up pacing event was a unipolar configuration at higher output and would be perceptable. Today, the autothreshold testing algorithms in ppm and icds is more seamless, but there are a few folks that make me wonder if they are feeling it. 3. An important part of the history is pattern. Does it happen the same time of day? is it relative to activity? Is it associated with any other symptoms? These are all important b/c they help determine if it is an algorithm issue or, maybe, they are RV pacing occassionally b/c of undersensing something or failing to capture the atrium. Obviously, if I suspect that it is an algorithm issue, I educate the patient about it. If I determine that there is a significant benefit to longevity to leave it on, then the patient and I decide together if it is worth the occassional palpitation. If there is no significant benefit, then I turn that off. Link to comment Share on other sites More sharing options...
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