Heart Muscle

I've had my pacemaker for almost 4 years now and am paced 100% of the time. During my last check, the doctor mentioned testing my heart to see if the heart muscle was being weakened. I always have had a lower blood pressure - even long before the pacemaker, but I just switched doctors and this one is concerned about it and wants to blame the pacemaker. Has anyone else had a doctor concerned about the pacemaker weakening the heart?

10 Comments

Manufacturers

by golden_snitch - 2013-06-27 01:06:29

And here's some info from pacemaker manufacturers on special features to reduce ventricular pacing and why they are needed:

http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiac-rhythm/therapies/unique-features/managed-ventricular-pacing/index.htm

http://www.sorin.com/product/replytrade-dr

https://clinical.sjm.com/clinical-challenges/ventricular-arrhythmias/less-right-ventricular-pacing.aspx

http://www.biotronik.de/en/se/29085

The manufacturers would not be spending that much money on developing these special features, if there wasn't strong evidence that the less ventricular pacing, the better.

Sorry, but you're wrong...

by golden_snitch - 2013-06-27 01:06:41

100% right ventricular pacing can be a reason for heart failure or worsening of heart failure or occurence of AF, DEFINITELY! Just for a start, a few articles:

http://www.ncbi.nlm.nih.gov/pubmed/22189959

http://www.ncbi.nlm.nih.gov/pubmed/19695453

http://www.ncbi.nlm.nih.gov/pubmed/15828875

http://www.medscape.com/viewarticle/528590

http://circ.ahajournals.org/content/107/23/2932.short

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356590/

Inga

Thanks

by RebeccaJean1 - 2013-06-27 02:06:23

Thanks so much for the links. I'll definitely read up on it. So far all the research I've been able to find is focused on the elderly (I'm only 32) or is focused on people with other underlying issues. Thankfully other than my AV node problem, I have no other health issues. But it also makes sorting through information on a Google search difficult.

Good question...

by golden_snitch - 2013-06-27 02:06:30

Hi Rebecca,

glad you found my replies helpful. Regarding your question, if exercise could help in that situation, I'm not sure. The heart failure in this case is caused by the ventricles not beating insync since one is paced and the other is not. So, I'd say exercise does not change this asychroneous pumping. But exercising is always good for the heart, especially endurance training. Even patients with heart failure are encouraged to exercise moderately. My guess would be that a well trained heart muscle can probably compensate some degree of asynchroneous pumping? But, again, I'm not sure.

I'd say it's good that your new doctor is aware of the risk that comes along with right ventricular pacing, and that he keeps an eye on your heart's function.

Inga

One more question

by RebeccaJean1 - 2013-06-27 02:06:59

Inga,

Do you know if exercise can help the situation or if it may even worsen it?

Currently, I have no real evidence of any weakening. There was some concern about my blood pressure which brought the subject up, but I don't think it's a real problem. Just something they want to make sure they watch and don't miss.

I have a question - or two...

by donr - 2013-06-27 09:06:03

1) WHY do you have a PM? You never told us.

2) WHERE are you paced 100%? Atria? Ventricles? This makes a BIG difference.

The way I read the thread, Comment #1 (Inga) assumed it was ventricles & gave an appropriate answer.. I'm paced nearly 100% Atria - but only single digit % in ventricles. Comment by Belle apparently assumed nothing about your pacing & gave an appropriate answer for someone in my situation. Which is it?

Don

Answers for Don.... Maybe

by RebeccaJean1 - 2013-06-27 10:06:45

Sorry I didn't give a better background. I was trying to keep things to the point and didn't realize how much I left out.
Originally I had AV node re-entry tachycardia. They think I was probably born with it, so when my symptoms got bad enough for me to realize there was a problem, it was beyond something medicine could control. So they did an ablation and killed the AV node. I did so well afterwards that I didn't get pacemaker immediately. I had third-degree heart block, but was able to keep my pulse in the 60's and the doctors were ok with this. Looking back - not sure it was the best decision on the doctor's part. After about a year it was wearing on me and my pulse was slowing to the 50's and that's when they put in the pacemaker.

The answer to your second question is harder. I have no idea where I am paced. I know that the top half is the half that is beating on it's own and the pacemaker is telling the bottom half when to beat. Does that mean the Ventricle is the one being paced?

I didn't realize how little I knew about pacemakers until I found this sight earlier today. I didn't even really know any questions to ask the doctor. I'm making a list of all the things I need to talk to him about. I mentioned earlier that I just got a new doctor. I really think he's going to be a lot easier to talk to than my previous one.

Studies...

by golden_snitch - 2013-06-27 11:06:09

Hi Rebecca!

Yes, several studies indicate that the more you pace in the right ventricle, the liklier you are to develop heart failure and atrial fibrillation. So, patients who are paced 100% in the right ventricle are at a higher risk than those who are paced atrially only, have a low ventricular pacing percentage or are not paced at all. Happens mostly because the ventricles do no longer beat totally insync - one is paced and therefore beats a tiny bit earlier than the other ventricle that is not paced.

However, this does not mean that you will for sure develop heart failure. Some do, some don't. One would think that patients who have 100% right ventricular pacing for a long time, for instance 10, 20 years or even more, are at an even higher risk, but the studies have shown that there is no definite correlation between the years you are paced and the risk of heart failure. There are patients who are paced 30 years and have no problems at all with heart failure, and there are some who develop heart failure just after a couple of months of 100% right ventricular pacing.

So, ever since this risk was discovered, pacemaker manufacturers are working on special pacemaker modes that will reduce ventricular pacing in those patients who do not need it 100% of the time. And some doctors check those patients, that have lots of ventricular pacing, more often for signs of heart failure, especially a decrease in their EF (ejection fraction). Usually this is done by using an ultrasound of the heart. Patients who do indeed develop heart failure are usually upgraded to a so called CRT system = a pacemaker with three leads, so one in each ventricle and one in the right atrium. This device helps to re-sychronize the ventricles and thereby improve the EF.

So, it won't hurt at all to have your doctor check your heart's function more regularly for signs of weakening. Might never happen, but if it does you want to catch it early and do something about it.

Best
Inga

NO WAY

by belle - 2013-06-27 12:06:15

No way, I got CHF from a virus, and the defib saved my life and made my heart stronger, no way, a heart muscle gets weak for a variety of reasons, none of which is a pacemaker. I live in New York City and go to the best Hospital Columbia Pres and trust and believe me the pacemaker HELPS your heart not weaken it.

You are Ventricularly paced...

by donr - 2013-06-28 12:06:32

so Inga was correct - you have a potential problem w/ asynchronous functioning of the ventricles - unfortunately, this brings up another question - what kind of PM do you have? Most likely it is a dual chamber type that is capable of pacing ONE of the upper chambers & ONE of the lower chambers. Some people have PM's that are capable of pacing BOTH lower chambers simultaneously. This solves the problems that Inga talked about..

A lot of people leave out necessary details of the why & what & how of getting a PM. Those details are necessary for correct info to be returned.

A little advice from your grandfather - you face a long row to hoe as a PM host. You have to learn as much about them as you can - & this is the place to start. Start by getting a copy of the download strip from the Cardio next time they do it. There is a wealth of info in there about how you & your PM interact - including data on which sections of your heat is paced & the % of the time it is paced.

There are many decisions that YOU should be making - at least your cardio should have your input into what is going to happen. It matters not how competent your cardio is, YOU must be captain of your ship, master of your destiny.

Good luck. If you look at some of the reports Inga has given you, you will have a start on becoming educated about your PM & how it affects your life.

Don

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You have a little piece of high-tech in your chest.

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