Your name is called and you are taken into a room – You are surprised that your appointment is on time!
You sit on the Uncomfortable Chair – The comfortable ones are in the staff room.
We ask you “how have you have been?” :- One of the most important aspects of the check! if you feel well and we find the pacemaker to be working as it should and as efficiently as it could. We won’t change anything, I mean why would we. I call this the “if it ain’t broke don’t fix it” Theory. If you tell us that something isn’t right we immediately start to think of what could be happening and can we use this pacemaker settings to help. When a patient describes symptoms this always starts the cogs turning in my head – pass the WD40.
We stick four stickers on you and connect some wires to them:- This is an ECG we get a live feed on our screen of everyone of your heart beats it helps us decipher what is going on, run our tests and preview our changes.
We ask “Can I see your pacemaker scar please?”:- We are keeping an eye on a few things, is the pacemaker infected, is it so prominent that it is rubbing and becoming sore, is it poking out are the wires being twiddled, is it where it should be. Unfortunately all of these things can happen, so we check every time we see you! (Thorough).
We place a header over your pacemaker:- The heavy thing we put on your chest with a lead coming from it. This is the communication unit, it talks to your pacemaker and feeds the information back displaying it on to the screen that the technician looks at. If you were a Robot, your hard drive has just been downloaded and YES I was tempted by a Heart Drive pun!
The printer churns paper, and more paper, and even more paper:- No, this isn’t a personal vendetta between the healthcare industry and the Brazilian rainforest, this is a load of useful information that we need to put in your file so we can assess for any changes from check up to check up.
We go quiet and start to read the paper and point at the screen with our finger!:- The screens are mostly touch screen or we use a pointer (Stilus) we are reviewing the information acquired. Here are the core things that we look at, our bread and butter…
- Parameters: This is a posh word for settings, how is your pacemaker set up: Without knowing what the pacemaker is supposed to be doing, how would we know if it is doing it correctly? Examples of pacing parameters are Lower Rate and Upper Rate.
- Alerts: The pacemaker will alert us of anything that it thinks is of concern, most of these alerts are in reference to the following information.
- Histograms: These are your heart graphs, they tell us the ‘spread’ of your heart rate since we last reviewed you. Has your heart had a nice spread (mostly 60-80bpm) with a few higher rates when you exercise. Or has your heart spent most of the time racing at 120bpm?
- Percentage Pacing: How much of the ‘work’ is being done by the pacemaker – has this increased or decreased since your last visit? can we get the pacemaker to do less work?
- Most Switch Episodes/Duration: If you have a dual chamber device (a lead in the top of the heart and a separate lead in the bottom of the heart) They have a facility called Mode Switch. If the top of your heart starts to misbehave (E.G. Atrial Fibrillation) then the pacemaker will ‘switch’ modes. How often it has done this helps us build an understanding of your hearts ‘behaviour’ since your last visit.
- Arrhythmias : High Atrial Rates and High Ventricular rates (Potential Arrhythmias) are monitored and recorded by the pacemaker, a bit like a loop recorder they document if the heart has had any fast/irregular rhythms and if so how long they lasted and how often they occurred. Useful information for us to give your Cardiologist – Do your meds need reviewing?
- Battery: We get a few facts and figures about the battery but ultimately they tell us one thing, How long has the battery got left?
WOW I hear you cry, that’s quite a lot of information to take in! You are right and it is why we go a bit quiet and distant, we aren’t deliberately rude….always 🙂
Now for some testing- Now the tests I am about to run you through can often be done automatically by the pacemaker, but we like to make sure the device is getting it right… and plus we want to keep ourselves in a job! These devices are getting way too clever…
Sensing:- So lets consider the most simple pacemaker, when your heart doesn’t make itself beat the pacemaker SEE’s this and sends a pulse to initiate a beat. If your heart does beat the pacemaker SEE’s this and doesn’t do anything. The sensing is is related to this and in fact is going to need a whole blog post to itself! We may say stuff like, “I am just about to slow your heart down a little, you may feel a bit light headed – if you do, let me know and I will stop the test.” – We are basically telling the pacemaker to hold off for a little and trying to encourage your heart to beat by its own accord. I am going to do a dedicated post and when I do you will be able to click HERE and see it.
Pacing Threshold:– Wow I am glad I have already explained this one click here for the Low Done
but basically this is testing how much energy is required to make your heart beat! We can learn a lot from this..
Lead Impedance:- You won’t know this is going on, in some devices it is automatic and in others it takes a couple of seconds. The lead impedance is a measurement of the ‘resistance’ down the lead. This is a good indicator of the condition of the lead and its connection with your heart muscle. Measured in Ohms a high lead impedance can suggest a lead fracture and a low impedance can indicate an insulation break.
NB – These tests we run are incredibly safe, knowing what I know if I was having a pacemaker check I would be so relaxed I’d probably have a sleep.
Once we have run these tests we have a quick look at your Parameters again… we ask ourselves this question “Given all the information from the check thus far, is the pacemaker set up correctly?’ we then make any changes we need to or just check everything is as it should be!!!
If a patient is experiencing symptoms we ask ourselves is there any settings that could be causing this or what can we do to improve this. Once we are happy….
The Printer starts up again:- We are printing out the parameters that we left the pacemaker in this way if you phone in, we know exactly how your pacemaker is set up! Its easier than guessing…
We tell you all our tests have shown that the pacemaker is working well! – We have finished our tests and it is time to go home, we book you your next appointment and you escape us…. for now 🙂
A complete explanation of these topics and more is available in the book Pacemakers Made Easy by Carl Robinson.
P.S. There are other tests and information we have at our disposal but for now this is the essentials!
Right time to for a Gym Circuit
Catch You All Later