First follow-up appointment and pacemaker settings/adjustments
As I sit here writing this post I can’t believe I’m post-op day 12! On post-op day 9 I had my first follow-up appointment with my electrophysiologist. He was extremely happy with how I was healing and finally cleared me to drive again! I still have the restriction of no lifting my arm above the shoulder/no lifting more than 5 pounds for 6 weeks. Along with no sports such as horseback riding, no work due to related heavy lifting for 12 weeks so the leads/pocket can heal properly. We were both surprised to find out I’m pacing 32% of the time, seems as if I needed the pacemaker more than we thought!
I have a Medtronic Azure dual chamber pacemaker. I asked my EP doctor before the procedure if I was a candidate for the Medtronic Azure because I thought the MRI capability, bluetooth, and average battery life of 14 years were important features. It turned out he was planning on implanting this device for similar reasons. Another reason he wanted to implant this device was its MVP (managed ventricular pacing) feature. Studies have shown chronic right ventricular pacing can lead to heart failure. Since I have these episodes of paroxysmal junctional rhythm my current pacemaker settings are AAI@60, MVP-DDDR. These settings mean that if an electrical impulse below 60bpm is sensed from the atrium, then the right atrium is paced at 60bpm. With the MVP feature, there is a ventricular back up if needed. If the pacemaker senses normal AV conduction is lost the pacemaker will change to DDD, both ventricular and atrial pacing. I no longer feel when my pacer is in AAI, but definitely feel when I’m being paced in DDD. I was briefly feeling those palpitations in my chest and was able to catch both atrial and ventricular pacing spikes on my Apple Watch EKG. The R in my settings means rate responsiveness. I have mixed feelings on this mode personally. The only change to my settings at my follow-up appointment was that rate responsiveness was turned on. Essentially Medtronic Azure has a motion sensor, if the pacemaker senses that you’re being active and your natural heart rate is unable to elevate itself the pacemaker will increase your heart rate to increase your cardiac output. Ever since my appointment I am having issues on and off with my heart rate being unnecessarily paced at a higher rate which induces a symptomatic tachycardic episode. These episodes seem to happen when I go from sitting for sometime to standing up and doing something. I called up my clinic and they said if it is happening primarily when I go from sitting to standing it is most likely rate response related and it can be turned off. I am giving it some more time to see if my body adjusts.
Patient’s at my clinic typically have their second follow up appointment around the 6 week mark. Six weeks is usually when the leads have healed over, during this time they typically decrease the sensitivity. Medtronic Azure has built in technology that at the 6 week mark it decreases its sensitivity on its own. I don’t have my next follow-up appointment with my EP for 3 months!
I also want to mention while in recovery I was met by a Medtronic Rep. He gave me one of the My Care Link monitors to keep at my bedside for transmissions. No one told me about the bluetooth app, I read about it online myself before hand. I had one of these monitors previously because of my loop recorder. It was annoying I had to keep it within 10 feet of my bed and when I wanted to travel I had to lug it along. I asked him myself if I could receive the app. Apparently the app takes a few days to become active and since it was not set up before my procedure I had to go home with the monitor temporarily. A few days later I called the company and set up my app. No more monitor stuck at my bedside, it tells me the average battery life, model and serial number, tracks your physical activity, you can log symptoms. I definitely recommend the app, I find the app very convenient!