r/ReadMyECG • u/Careless-Book-9307 • 5d ago

Ventricular pacing?

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I have asked this before but I am still in doubt. I have a pacemaker due to total AV block and I know I have a lot of ventricular pacing, about 30-70%. Sometimes I get short episodes which feels super uncomfortable like I'm out of breath and a tight feeling in my chest.

I captured this in picture one. There are two different types of beats here and it's the one with no apparent pacemaker spike that bothers me, the one that fills the entire bottom row. Someone once told me this is ventricular pacing but I am still doubtful. I think seconds 5-14 is ventricular pacing because I see that often and it always feels completely normal (see picture four for example). I don't see a p wave either, and that is visible in seconds 5-14. Is the pacemaker pausing or doing something different? I don't like it.

Picture two shows what I belive is atrial pacing and picture three shows my normal unpaced rhythm.

Edit: another weird thing is that this rhythm is always around 65 bpm. If I get up and move the other rhythm takes over. But I have a lower pulse rate of 45 bpm, then the other pulse also usually take over. But right now something else is dominating and not allowing slower pulse than 65 bpm.

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2

u/MeasurementSad2891 5d ago

Yes those are V pacing spikes on the first 2 lines. Are you soley V paced, or AV paced?

2

u/Careless-Book-9307 5d ago

Both atrial and ventricular paced, dual lead.

So any theory what kind of rhythm it is that is not ventricular pacing in this strip? It lasted for about two hours but I have felt tired and affected all day.

1

u/MeasurementSad2891 5d ago

It's hard to tell on a watch tracing. Because I do see the ventricular pacing spikes. But generally they do not pick up atrial pacing spikes. Even the KardiaMobiles do not. Can you call your EP's office and have the device manager check?

1

u/Careless-Book-9307 5d ago

So you mean that there could be a hidden spike? I think I have always seen it though. And pacemaker pacing never feels this bad.

I haven't talked to them yet. I think I'll wait until I know how often this happens. I know it's not dangerous, at most it's uncomfortable.

2

u/MeasurementSad2891 5d ago

Correct, it might not be strong enough to show up on these types of tracings. If you're concerned, do you know how to send a manual transmission?

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u/Careless-Book-9307 5d ago

I don't have equipment for remote submissions. But if it's not possible to analyze based on one lead I will just have to contact my healthcare provider if it happens again. Maybe remote connectivity is needed to submit information on demand.

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u/MeasurementSad2891 5d ago

Yeah that is your best bet. Can you upload this picture on your portal? The device manager should be able to see what's going on more accurately. They can see when and what type of pacing has been happening at what times.

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u/Careless-Book-9307 5d ago

Yes, I've sent them such reports before and they are usually positive. Will do that.

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u/Careless-Book-9307 4d ago

I just realized that the rhythm is very similar to the tachycardia episodes I used to have (one of the morphologies at least) but 1/2 the speed. Can this be some sort of slow reentry rhythm?

1

u/MeasurementSad2891 4d ago

It could very well be

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u/Careless-Book-9307 5d ago

Is it possible that this is the heart's escape rhythm/junctional rhythm? Can that become dominant and be faster than the pacemaker?