Ablate and Pace for Atrial Fibrillation talks about a similar situation and perhaps more of a general idea of the whole deal.

Ventricular Tachyarrhythmia has the idea captured and with a bit of poking around the Mayo Clinic you can get a better idea.

I was reading in the Canadian Journal of Cardiology and although fine it was a bit deep. You must know the terminology in simple reference to the areas mentioned.

Arrangements have been made to obtain a pacemaker and the actual time has not been set. Mental preparation for this one is much greater than before. This is a major step in her healing. Keep in mind this may sound as though it is not unusual for pacemaker placement but she has a different set of circumstances. From what we could gather it was a challenge to decide from what was available and how to best tackle the situation. The typical ablation / pacing story is well documented but she has an underlying history that may keep the Electrophysiologists on their toes. If another study is required she may in fact wig out.

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990510 (D2M) Only one day after Mother's Day, Carolyn has a belated gift of renewed heart rhythm once again. Sporting a late model Medtronic's VDD** single lead pacemaker she has been "kicked up a notch" & will be on the road again before we know it.

** VDD - the type of pacemaker that only very few of this type exist today is a single lead multi- purpose cardiac pacing device. The single lead has dual sensors to detect activity in the atrial and ventricle portions of the heart. The atriums are the "pumps" that deliver the blood to the heart and the ventricles are the ones that "do the pumping" to the rest of the body and lungs, etcetera. It was determined the timing between the Upper (atrial) and lower (ventricle) was lost and perhaps not returning. To reinstate a quality of life we take for granted the device senses the atrial activity and paces the ventricles accordingly. The device will also inhibit any ventricle action if not so necessary by or without the recursive action of the atriums. This means there will now be an opportunity for blood to fill the chambers before the pumping begins. Not a chaotic erratic fashion as it has been in the past. The pacing only is required in the lower portion and again timed from the calculations sensed from the dual sensors (I'm sure this makes the device rare and expensive) on the single lead.
Guys - read, the valve and ignition timing are once again in sync with active advance from pressure, voltage and governed speed detected from two sources. The self contained speed advance and governed unit is set for a maximum bpm of 160 and red lining at this speed has yet to be road tested. The unit is a very small compact stainless steel alloy construction of impressive design with a single coaxial connector top mounted. The telemetry (diagnostics connection) is done from a portable magnetically coupled transducer running a proprietary suite of hardware/software. Diagnostics is initiated by introducing a strong magnetic flux within the area the unit is located, drivers side.

So far it works! Tonight when I left she was humming along at a very peaceful and content 72 bpm. Her QRS patterns/waves were looking good and constant. (briefly, QRS is a reference to the cardiac waveform that gives each peak and valley a notation in relationship to each other) Prior to the surgery/placement her atriums were firing well before the ventricles at a slow 40 to 43 bpm. This is not good and raises several eye brows. If this means anything it was written up as a third degree heart block & as I understand it is a complete disruption of internal timing.

For several hours she was "confined to bed" and shortly there after she attempted a walk about (only a short distance, and you can guess to where). This was an actual test of the new work of Dr. Kieser (spelling??) and she passed. From a relaxed 75 bpm she quickly counted into the eighty's and beyond. Once she returned to a sitting/ laying position it was only a minute or so before she was back to normal. I would have jumped up and down but thought the audience may have misunderstood.

Recovery is unknown (as of this writing) but minor drug therapy and restricted movement limits her mobility for the next six weeks. The pacing lead has yet to establish a firm and solid foundation with expected scar tissue within the interior wall of the heart muscle. If a text book example (history has been written in her case) was to be followed she would be up and back to normal in 2 to 3 months. I can only guess in her situation & when we ask the experts it's, "come and see me in a month." Speaking of one month, she is due at the pacemaker clinic for regular "tune up's" at a gradually declining rate as time passes. After a year or so passes it will be an annual thing for the expected 10 year life span of the device and then replacement with I'm sure a spiffy new fangled device by then.

The day started off with a call from the hospital admitting saying that she could arrive sooner for surgery commencing at 11:20 AM with Dr. Rothchild with a check in time several hours before hand. This was of course welcome because the last call for surgery was at 12:45 PM and this would get an earlier start. This would mean with a different surgeon but would not matter since we have heard good things about both of them.

Once arriving at the admitting desk it was time for blood tests and wait, then wait, & when this was done we wait some more. Then it was off to the fourth floor to have more admitting interviews and get dressed for the occasion. She is requested to provide a ECG and this is done on the 9th floor and off we go. We return to the 4th to sit and wait. Then wait. The 11:20 time comes and goes, then 12:00 comes, hmmm, will she be bumped? Her name is called and we are off to the seventh floor for the placement. Here we sit and wait for the "sandman," the nurse Susan and finally the surgeon Dr. K. Dr. K and staff are very understanding, reassuring and pleasant & at about 12:40 it is time for the event. I have my instructions to receive her at the unit on the eighth floor and when the established time comes and goes I have already put several thousand miles on my shoes from hallway pacing. The estimated 30 minute procedure was turned into a 90 minute wait for the harried spouse.

I say the above not only as my concern for the length of the wait and uncertainty that goes with it but also as a sign that the former foothills hospital (now FMC, what ever that is) is politely, NOT organized very well. There, I've said it. I realize that medical procedures are almost always never the same but the preliminary paperwork and tests are pretty much set in stone as far as time and work required. Why would an almost four hour wait/delay be required for something that actually took about 15 to 20 minutes be necessary? There was nothing elective nor financial about it, perhaps as an observer I am a bit demanding, nay impatient spouse. As I have said before I have the highest regard for the staff but they are poorly guided and directed. Can we say mismanaged. I can now fully understand the client/patient stance on such things that have been given a lot of press time lately.

After all is said and done she should arrive home in the afternoon of Tuesday May 11. This is my thought but I think it is a bit early to get to this stage in the game due in part to treatment and care of the placement site. Of course not ignoring the fact the whole reason for doing this was to have a life altering step taken I believe nursing time should be extended. I have first aid training but give me strength, this is a little different.

Alex, I'd like pacemakers for $1000 please.

Composting would be an option but to have rotting grass clippings anywhere near the house is somehow flawed.

To be continued...