PMT?

[cvnurseann]

Hi, I'm 28 and had a pacemaker placed 4/14/10 for fairly severe sinus node dysfunction/sick sinus syndrome - I had 2 EP/Ablations (sinus node modifications for IST) in 2007, the last resulted in my SSS.  Until now I avoided a pacer since I am so young but was bradycardic in the 30's and 40's with 2+ second pauses, struggled with chronotropic incompetence, and was fairly symptomatic. (Oh I am a cardiac nurse too....)  I have a dual chamber Boston Scientific Altrua 60 set at DDDR and am about 68% A-paced and 13% V-paced.  I have felt so much better since my device implant, however I have been having fairly frequent episodes of tachycardia at rest.  Last week I had gained 9lbs and my ankles were swollen and I felt somewhat SOB.  I was at work (I'm a clinic RN in a cardiology clinic) and one of my ARNP's said I should have my echo tech look at my right heart pressures - I got on the table onto my left side and immediately went into a tachycardia at 162bpm that was AV paced, and when you put your hand on my diaphragm/lower sternum you could feel the thud of each V-paced beat.  The ARNP came in and looked at the rhythm (and felt my diaphragm) and said it was PMT (pacemaker-mediated tachycardia).  I rolled to my back for a 12 lead EKG and it terminated.  I went to see my cardiologist that afternoon and he adjusted the settings on my device and gave me a 30 day event monitor......but I'm still having tachy episodes. My question is, could this possibly be related to my ablations from 2007? I had a lot of erroneous activation sites around my sinus node that he ablated and I wonder if with the lead in the RA, it could be activating some of those sites if I do in fact have intact VA conduction?  Is it possible I will need a complete sinus node ablation to kick this PMT? I am otherwise a fairly healthy 28 year old.  Although I have an interventional cardiology background I have never been on the side of device checks and am not too familiar with the internal functions of the pacemaker and its programming.  So I do appreciate anyone who may have any input!

Thanks!

[PikaPika88]

I also in DDDR mode.  When it detected any abnormal rhythm, it'll mode switching to VVIR.  Every morning it starts to pace my ventricle when I awake (not standing or sitting up yet).  Not even open my eyes yet.... When it paces, my chest like an express train running.  My EP said, it top up the rate when I awake so that I can run for the day.

I didn't have any medical background.  I can't answer any of your question but I can share mine one with you.  My EP said mine pacemaker has a build in holter monitor.  It stores all my heart events.  He said I don't need to wear any holter monitor anymore.  Sometime I do believe the pacemaker can cause tachy but the docs don't believe it.  My heart still can make "pause" longer than 2.5 second.  The pacer didn't jump in and do it works....... The EP believes it because many of his patients caught the "pause".  He can't explain it.... probably the pacemaker slack.

[Jerry_NJ]

I respond to give your post a boost to the top of the list, and hope that someone with experience will read and reply.

I am not surprised at the lack of helpful input, your question is very specific and it is clear you have more knowledge and resources than most of us - I still hope one of our many heart patients will be able to share some insights.

Wishing the best,