This is a revision of an earlier posting on this subject, redone and reposted because I believe this is an important topic about which very little seems to be said.
In the first 4 years of living with a cardiac pacemaker (PM) implanted, the following instances of misinformation,lack of proper oversight,delayed reports and/or misdiagnosis occurred.I did not need that stress after having a titanium foreign body containing a 3 V battery crammed under my left chest wall muscle attached to wires going to various parts of my heart which was quite enough to ramp up my anxiety level to at least sub-panic attack levels.
1)In October 2015 I had a pacemaker implanted- one which is designed for bi-ventricular pacing the most common form of CRT (cardiac resynchronization therapy).This has 3 leads, right atrium,right ventricle (actually mine is in the His Bundle position) and a Left ventricular lead (in a vein along the wall of the left ventricle)
2)The technician who assisted and provided technical advice to the EP cardiologist at the time of the implantation told me on the following day that my home -bedside PM communication device would send a recording every night to the manufacturer's web site and then to the hospital PM center.
Only 6 months later was I informed by him , in reply to a question from me, that no -that was not true and that arrangement was only for devices with a defibrillator which I did not have. So for six months I made a effort to be near near by communication device device each night that in fact did nothing at all.Someone apparently had not read the manual.
2.In October of 2016 my device recorded several episodes designed as AF/AT (atrial fibrillation/atrial tachycardia) Episodes of AF are thought to be common ( at least 30% by three years in patients with a PM- according to one data base).This lead to to my fairly extensive literature review of the issue of AHRE ( atria high rate episode). I learned that the topic is controversial and opinion varies as to what if any threshold there is for "signficiant volume of AF" to justify anticoagulation. (There are 2 randomized clinical tarials underway that are designed to try and answer that question).So it was an opportunity to research a medical topic-fear being a great motivator.
Also, all AHREs so designated by the PM's algorithms are not in fact AF. The phenomenon of far field r wave sensing (FFS) and and a less common and more obscure PM rhythm disturbance known as recurrent, non reentrant ventricular atrial synchrony (RNRVAS) are capable of mimicking AF.The technician at the hospital PM center who is tasked with screening the remote interrogation report had not recognized that the rhythm was FFS and apparently did not feel that the issue required calling the matter to the attention of the EP cardiologist.
I send an email to my EP cardiologist and I was told the issue of short episodes of possible AF are very controversial and I did not need to come any sooner or consider taking anticoagulants. He apparently did not address the possible issue of FFS or RNRVAS or actually review my interrogation report until months later even though I has asked in my email if the data really indicated AF.
However three months later, at routine office followup a Medtronic technician said that the earlier interrogation did not actually show AF but rather FFS the reoccurrence of which he intended to prevent by increasing the sensitivity threshold(i.e making detection less sensitive) on the atrial lead. The EP cardiologist agreed, and I later leaned that FFS is not an uncommon cause of AHREs particularly so in the type of lead placement that I have. (Placement in the Bundle of His which in my case is higher up in the ventricle than the standard apical placement of the RV lead-sometimes the His Bundle Lead is in the atrium)
3)At an August 2018 in office PM interrogation, the technician and I entered into a conversation about battery life estimation and she wondered if the estimate of battery life was disproportionately shorter than what may have been expected on the basis of the settings .She forwarded the data to the home office and the engineers found nothing to do to improve the settings.Her concern and interest was appreciated but ..
In talking to her I quoted the section of the device manual that discussedto the device powering down a bit with several settings once three months has passed after the recommended replacement time ( RRT date). She said no that was not the case with my particular model However, I contacted the pacemaker company technical support and they confirmed the manual's description was correct.
4)Issue of high left ventricular (LV) threshold occurring on multiple of the every three month reports.It was not until October 2017 (2 years after implantation ) that the left ventricular management system was switched to "monitor". I can only speculate as to the degree to which battery life was shortened by what seems to be the less than prompt attention to that issue.
The interrogation report is fairly long and reviewing it requires considerable technical knowledge about cardiology,PMs in general as well as certain details regarding the specific brand,various programmable settings and particular model and various lead placement configurations and at least a little knowledge about electricity and cardiac physiology.
The device clinic technicians review reports from various pace maker brands and also the more involved and complicated reports from ICDs (cardiac defibrillators) .Being a retired physician I have had the time and interest to spend a fairly large amount of time and effort into learning about PM lore and in particular the interrogation reports. My shaken confidence in the folks monitoring how well the wires in my heart are performing has certainly provided incentive to learn how to read the basics of device interrogation reports.
5)By the summer of 4th year following implantation the device clinic services had deteriorated to the point that I wrote the head of the EP section.They no longer directly answered the phone and the messages left were only replied to days later and my complaints to them was met by curt replies that they were too busy. Reports that were typically available the same day took a week or more and required multiple phone calls . The section head said those issues were being addressed and apparently they hired a company that does device monitoring and were now also available 24/7 while their own in-house clinic also did some or all of their review work.How well that arrangement works remains to be seen. and I have not ben able to learn how the hosptial device clinic and the contract device monitoring company divide or duplicate the work.
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