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atrial/ventircular or dual chamber pacing

      Re: Re: Re: atrial/ventircular or dual chamber pacing

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Posted by CCF CARDIO MD - DLB on August 19, 1998 at 10:16:12:

In Reply to: Re: Re: atrial/ventircular or dual chamber pacing posted by mariette on August 19, 1998 at 08:24:53:

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  : Dear Mariette
  : I do not know your doctors personally, but I must disagree with your statement regarding doctors in the Netherlands. The ones I know are all excellent cardiologists.
  Mmmm I can imagine that it seemed a bit rude, but if you take the fact that I first got the wrong pacer first into account...maybe you understand why I say this. Added to the fact that they neede three surgeries (the last 5.5. hours) to implant the pacer....you can imagine....
  : I cannot comment on the specifics of your pacemaker programming. As far as the need for ventricular pacing, it depends on your underlying heart rate and the reason the pacemaker was implanted.
  I have sick sinus as well as AV-blocks (only 1st degree as far as we know). I take lanoxin and sotalol as well. Taking into account the 65% ventricular pacing...would it be wise to program atrial pacing only?
  So.. the questions remains.... you told me that an decrease of AV-period would be helpful to prevent the PMT's. Is in your opinion an AV-interval of 230 ms too long? I tried to persuade the pm-technician months ago to decrease this time... after he suggested to turn off the rate respons I lost track of thei nice suggestions and asked them to program the AV-interval on rate adaptive, which they did. It is still set at rate adaptive AV-interval and an interval of 230 ms (paced). PVARP is set at 310ms and PVAB at 150ms.
  I would very much appreciate your help with this matter. Is a PMT dangerous? Could it lead to other arrhytmia's?
  Thanks and I hope you were not offended by my remark about the cardiologists here... If you would know that whole story I think you would understand....
  Thanks so much for your time! Mariette
Dear Mariette
I only disagreed about the generalization regarding cardiologists in the Netherlands, some of whom are world-renowned. I am not in a position to comment specifically on your doctors without knowing the details of your case.
However, based on what you have written, it does seem risky to utilize only atrial pacing. If you do have sick sinus syndrome (and low heart rates at times) and if you are on digoxin and sotalol, both of which can lower heart rate, it seems like ventricular pacing, at least at a low backup rate, would be necessary. The first degree heart block, in and of itself, does not bother me.
AV intervals and PVARPs need to be individualized. An AV interval of 280 [which is what your first letter said], and even 230, can contribute (in some cases) to a pacemaker mediated tachycardia. Based on the pacemaker telemetry strips that document the PMT, the PVARP can be adjusted such that a PMT does not occur. I wonder if your doctors are referring to some other tachycardias as PMTs. PMTs, like any arrhythmia, can be dangerous if they go too fast and produce symptoms.
If you are unhappy with the care you are receiving, perhaps you should seek another opinion. The Thoraxcenter in Erasmus University is highly thought of.
I hope this is useful. I wish you the best of luck. Feel free to write back with further questions.
If you would like to set up an appointment with one of our cardiologists here at the Cleveland Clinic please feel free to call 1-800-CCF-CARE.
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your physician(s).

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