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Tachycardic episodes.


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Toogoofy317 non-obstructed hcm, AICD 11-01-02 and 10-6-05 Find out more about Toogoofy317
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  • Tachycardic episodes.

    I'm not sure if this is a real concern or just a major annoyance. For the past month and a half I've been having episodes of tachycardia. They don't just last for a few secods they last upwards an hour. Most of the time I notice it when I am on the couch or laying down. One episode my heart rate got up to 175 for about an hour. I have the AICD and it has never recorded any of this or anything for that matter. I was told that it is not set to deliver treatment until 220 bpm. I get very fatigued and light headed with these episodes. I gave Boston a call Monday but no call back. I'm just not sure if I should be running to the cardiologist about this or if I should just relax since I have the ICD.

    Any insights would greatly be appreciated!

    Mary S.

  • #2
    Re: Tachycardic episodes.

    Hi Mary, When you talk to Boston, ask what rates are monitored and recorded in your ICD without delivering therapy. Maybe if it doesn't record at 175 and yet rates at that speed bother you, they can drop the lower limit for recording. They can give you some insight about that. Good luck, Linda


    • #3
      Re: Tachycardic episodes.

      Hi Mary,

      I'm an EP/ICD nurse and visit this site weekly. Just read your tachycardia post. If your ICD is set to detect and deliver "therapy" at a HR of 220 bpm, then it will not "record" anything below that cutoff rate.

      Linda had a good suggestion in theory but that's not how the ICDs are set up. They cannot be "set to record rhythms, without delivering therapy" whether that therapy be a shock or what's called: antitachycardia pacing (ATP). ATP is a less aggressive form of therapy than a shock and involves delivering rapid bursts of pacing at a rate a little faster than that of the VT. It is used for different types of VT that are a bit slower where the patient still remains conscious and doesn't completely bottom out their BP, etc.

      Did you happen to have an EP study before you were implanted? If so, wondering if they were able to start up any "rhythms" from your upper heart chambers (atria) that would be termed: supraventricular tachycardias (SVT) which literally means: its origin is: "above the ventricles". This class of arrhythmias is not lethal like the Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) that you are at risk for with HCM, hence the reason you received your ICD in the first place.

      So what I'm getting at is one of 2 possibilities from what you are describing:
      1. You could be experiencing an SVT at a HR of 175 bpm. That can cause symptoms of lightheadedness and fatigue and last for anywhere from a few minutes to several hours. Then it can either terminate on its own or maybe coincidentally you may do something like a "strong cough" or have a "bowel movement", ie. things that make you "bear down, if you will," which could also stop the rhythms. Your ICD is NOT going to detect this because as you stated, your cutoff rate for detection and therapy is: 220 bpm.

      2. You could be experiencing a VT at a HR of 175 bpm that can cause all the same symptoms but is "self terminating in the same way as above."
      Again, your ICD will NOT detect or deliver therapy, because the detection criteria HAS NOT BEEN MET at 220 bpm.

      So what do you do?

      In order to determine how to treat you, they need to "catch" you when you are having the tachycardia. That can be done by: going to ER and hopefully being seen and hooked up to a monitor and MOST IMPORTANTLY A 12-LEAD EKG before the tachycardia resolves. Alot of times, by the time the pt is seen their rhythm has resolved and they've spent all that time in the ER for nothing.

      2. Have your Cardio/EP set you up with an "event monitor" which is worn for a certain period of time (weeks up to one month) and has a method to mark the monitor and record your symptoms at the time, which will be correlated with your rhythm strip at that time.

      3. A newer type of "event monitor" that is out now and much more comfy and convenient is the "Cardionet", it's a wireless symptom that has a cellular phone transmitter in the monitor portion and can transmit the recordings right at the time of occurrence to a central monitoring station and then on to the MD right away if it is determined life threatening. It also can be preprogrammed so that since you have an ICD that's set at 220 bpm, if you have VT at 220, it wouldn't necessarily need to record that, since that episode will already be recorded in your icd and wouldn't need to notify the doc.

      So there are some options/info...

      Hope it's been helpful, please keep us posted.



      • #4
        Re: Tachycardic episodes.


        Forgot to add to my post: when you said you didn't know if this was an annoyance or what....

        if you are lying or sitting down and having lightheadedness with these tachycardia episodes, then please take them seriously.

        If it does happen to be VT below your cutoff rate, the chances of it not self-terminating are greater and it can deteriorate into nastier, faster VT or VF which can cause you to pass out (which is termed "syncope"). Obviously if you can avoid passing out, that is the best scenario, because you never know what you may be doing... ie. driving a car, holding a small baby, crossing a busy street, etc.

        Anything that causes lightheaded, in my opinion, needs to be taken seriously, especially with your history.

        That's just my 2 cents worth. Don't mean to scare you, but don't want you to "blow it off" either.

        Lots of luck and hugs,



        • #5
          Re: Tachycardic episodes.

          Laurie - I think what Linda is referring to is the monitor only zone, where the ICD will record irregular rhythms over a certain setpoint, but not treat. For example, my ICD is set to monitor but not treat arrythmias over 150, and is set to treat arrythmias over 200 bpm.

          My device records lots of stuff which allows the doctor to read the codes, and tell from where the arrythmia originates.

          Mary, this is something you can investigate...having your device programmmed in the monitor only zone so that your doctor can decide how to best treat your episodes. Also, if you have certain Medtronic devices (I have a Marquis DR), you can interrogate and transmit the info. over the phone without a doctor visit. I use this service, and its great for busy people like you...esp. since your doctor isn't local.

          Good luck, and I am thrilled to hear about your new job! I was about to come to Florida, take the bar exam, and sue that Mouse myself!

          P.S. Laurie, just f.y.i., most HCMers don't have EP studies before implantation b/c they haven't been found to be very informative w/ regard to the risk of sudden death in HCM. You will find a few here that have had them, but its not the current recommendation.
          Daughter of Father with HCM
          Diagnosed with HCM 1999.
          Full term pregnancy - Son born 11/01
          ICD implanted 2/03; generator replaced 2/2005 and 2/2012
          Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.


          • #6
            Re: Tachycardic episodes.

            As a matter of fact I did have an EP study at Shands University of Florida. Don't go there!

            They were able to get VF but they said it was inconclusive. They actually shocked me while I was awake. I know why they strap you down for that test. Other than that nothing else occured. I had burns on my back and chest and they sent me home for the two hour drive thirty minutes after the procedure. They told me I was perfectly fine and did not need an ICD. Later I found out I had four risk factors for SCD.

            I did try an event monitor in the beginning and it killed my skin the electrodes wouldn't stay on and they could not get any readings. When I did the 24 holter is when they caught the V-tach. Oddly enough it was not when I was having symptoms.

            I just put a call in to Dr. Maron and get his opinnion about it. Then I'll make an appointment with the local cardiologist and discuss it. My primary physician didn't seem to concerned with it.

            Well I got school soon 20th century humanities and public speaking. For those who know me I get really shy when I talk to people I don't know!

            For those who don't know me I am a presenter and I do demonstrations at Disney all day! So this public speaking class well I don't know!

            Mary S.


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