A good check-up, and a new experiment

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epstns

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Well, I had my 3-month post-op (much delayed due to doc's schedule) pacemaker interrogation and consult with my electrophysiologist. The pacemaker is in fine shape - leads are solid and present good connectivity, very little skin irritation from things rubbing on it, etc. Atrial pacing takes place about 60% of the time and ventricular close to 100%. No real change there. The high percentage of ventricular pacing is because I have some A-V node disturbance and the time delay between my atrial and ventricular pulses is too long, thus the pacer triggers my ventricle. So it has been, so it is.

That's the OK news. Now the interesting stuff - I do still have some underlying natural ventricular pacing taking place, but it is not yet strong enough to rely upon. This is an apparent improvement over the last check-up when I showed no native pacing. Time will tell whether or not this pacing will grow strong enough to dial down the pacer involvement. We've decided to wait and see.

And now the really interesting stuff - for me, anyway. After having a "life-style" discussion update with my electrophysiologist, he agreed to change some of my pacer parameters. Initially upon implantation my pacer was programmed to allow a range of heart rates from 60 to 130 BPM. I had tried to get them to increase the upper limit last visit, but they held fast, wanting to give my heart more time to heal. This time, after hearing the report of my progress to-date at rehab, they agreed to increase my upper limit to 150 BPM. This should give me some extra capacity for jogging and other higher intensity cardio activity. They also turned on another "rate response" function. Initially they had enabled only the vibration/motion sensor, which increased my heart rate when it sensed my body bouncing - as in running outdoors or walking. This did nothing for exercises that didn't bounce me up and down, and even walking on a treadmill was less than thrilling, as it cushioned the bounce. So, we turned on the respiratory rate response function, which will raise my heart rate when it senses my breathing rate increasing due to exertion. That will be interesting to try out this afternoon at rehab.

Now for the really great news. NO MORE AFIB! I have been taking warfarin since surgery due to a bout of afib post-op. According to my pacer logs, my last incident of afib was on March 27, so the EP agrees that the afib was most likely a common case of post-op afib, not chronic. With this major observation he agreed that I can now safely discontinue the warfarin! One more pill bites the dust! Now I just rattle a little bit from all the pills I gulp down daily.

All in all, I'd call it a really good outcome. Now to see how this baby runs now that we've done a tune-up and advanced the timing a bit. . .
 
Sounds like you had an excellent appointment, Steve.
What good news you can stop the warfarin. Congratulations.
Let us know what difference you experience with the higher pacer settings.
Hope you notice real difference.

Happy to hear how well you are doing.
 
This is a great update! I'm so reminded about how long healing takes. It really is like a year. I'm hoping that in a years time your pacer is not pacing nearly as much. With God all things are possible. In 5 years you may be surprised that your barley using the thing. We got to only believe! I'm so happy that they upped your limit, hope for good results at rehab.
 
You are sooooo gonna love those extra 20 beats per minute. It makes so much more possible, speaking from personal experience.

You made me wonder if my respiratory response is enabled...I hit 145 to 150 pretty easily on the vibration, to the point I can't use a treadmill, but the elliptical doesn't seem to trigger so much response. Of course, that could be the 900 beta blockers I'm on, too.
 
Well, after the first rehab session since the pacemaker adjustments, I have only one comment. . . WHEEEEEE! My performance on the stationary bike went ballistic -- it actually feels like I could ride a road bike and not get run over by the kids on tricycles! In terms of the effort units on the Airdyne, I'm at a level easily 20% higher than before, and that wasn't even my max. I just ran out of time.

Today was an off day from rehab, so I went to my regular fitness center. For the first time since surgery I was able to jog 2 full miles without having to slow back to a walking pace! Before the pacer adjustment, I had to be satisfied doing intervals -- walk 1/4 mile, jog 1/4 mile, repeat until exhausted. No, I'm nowhere near the pace I used to run, but run I do! I did my 2 miles in 26:20, for an average pace of 13:10. It is a start, and I'm sure I can improve on it now. What a difference a few programming changes can make!

Topless - I'm still taking a few meds. Mornings I take 100 mg of metoprolol (generic Toprol XL), 12.5 mg of HCTZ (diuretic), 81 mg aspirin. Evenings I take 20 mg of Lipitor. I also take Zantac for GERD, 3 X 75 mg/day. Nowhere near the pharmacy I was taking when I first came home from the hospital, but enough to remind me of what I've been through.

I think I'll let these changes settle down and then maybe in a few months I'll talk to my cardio about reducing the beta blocker and if necessary adding another med to control BP. Might not be necessary, though, as the beta blocker doesn't seem to impede my heart rate. I think the pacemaker just ignores it, so the beta blocker does not have the same effect on me that it does on people who are naturally paced.

Now to see how things progress, now that I have a more normal range of heart rate. I'm stoked!
 
Well, after the first rehab session since the pacemaker adjustments, I have only one comment. . . WHEEEEEE! My performance on the stationary bike went ballistic -- it actually feels like I could ride a road bike and not get run over by the kids on tricycles! In terms of the effort units on the Airdyne, I'm at a level easily 20% higher than before, and that wasn't even my max. I just ran out of time.

Today was an off day from rehab, so I went to my regular fitness center. For the first time since surgery I was able to jog 2 full miles without having to slow back to a walking pace! Before the pacer adjustment, I had to be satisfied doing intervals -- walk 1/4 mile, jog 1/4 mile, repeat until exhausted. No, I'm nowhere near the pace I used to run, but run I do! I did my 2 miles in 26:20, for an average pace of 13:10. It is a start, and I'm sure I can improve on it now. What a difference a few programming changes can make!

Topless - I'm still taking a few meds. Mornings I take 100 mg of metoprolol (generic Toprol XL), 12.5 mg of HCTZ (diuretic), 81 mg aspirin. Evenings I take 20 mg of Lipitor. I also take Zantac for GERD, 3 X 75 mg/day. Nowhere near the pharmacy I was taking when I first came home from the hospital, but enough to remind me of what I've been through.

I think I'll let these changes settle down and then maybe in a few months I'll talk to my cardio about reducing the beta blocker and if necessary adding another med to control BP. Might not be necessary, though, as the beta blocker doesn't seem to impede my heart rate. I think the pacemaker just ignores it, so the beta blocker does not have the same effect on me that it does on people who are naturally paced.

Now to see how things progress, now that I have a more normal range of heart rate. I'm stoked!

Hell yes! I love it! Show and prove! This is very exciting news. Thank you for sharing.
 
Good progress, Steve, don't stop! Your exercise at 3-ish months continues to be more strenuous than mine at ~8.5! I'm still at 3 miles of 3:1 walk-jog, which took me 43 minutes at Wednesday's rehab class.

I wonder why you couldn't also drop the BB, 5 months after your latest A-fib. Wasn't it prescribed mostly for A-fib?
 
Norm - I think the BB was prescribed for both AFIB and to control hypertension. I have an appointment with my cardio next week and will ask him what options we have. Prior to valve surgery I was taking an angiotensis receptor II blocker (Avalide) for high BP, and it worked really well for a number of years. Maybe we can go back to that one.
 
Hey Steve,
Congrats on your good appointment. I can only really comment on your pacemaker settings, but I had an appt about 9 months post op for my pacemaker, and the nurse said my heart was doing all the work on it's own. After several more appts, and mode switches, having the Medtronic engineer involved I have some pretty good settings now.
It sounds like you have an escape rhythm in your ventricles, where you could likely stay alive if you pacemaker just stopped working. My natural AV delay is also longer than normal, so the pacemakers AV delay was lengthened to give my heart a chance to do it's own, but if not the pacemaker will kick in. I am not sure how often this is happening, but I am sure I will get the percentages next appt.

Congrats again, and there is still lot's of hope more of your conduction will come back.

Cam
 
*grins*

That ... my friend ... is AWESOME. Glad you are making progress ... and the visit turned out well.



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