Question on Setting and EF

I am new to this forum. But I have no answers. My daughter who is almost 4 had an adapta pacemaker implanted in 2011. It was set in DDD mode low rate is 80 and high is 210. They also set it in sleep mode for at night at 70. She recently was hospitalized and had her mitral valve replaced with a mechanical valve. The surgery went good. But after surgery she was pacing extremely fast. They thought they had figured the problem and increased her sensitivity in the ventricular lead. A day and half after she was taken off of milrinone her ejection fraction went down. The dr's talked about adding a lead to the adapta pacemaker, she has a lead on her atrium and her ventricle. They put her back on milrinone and her ef went up. Switched her to enalapril and her ef looked good. 2wks post discharged, so about 5 wks post op she was in for a check-up did an echo and her ef was at about 45-50. when she left the hospital it was at 50. A week after that appointment I was concerned about her sweating and took her in to see her primary doctor. Her primary talked with the cardiologist and he said they wanted to see her. Went to see her cardiologist, did the x-ray and he confirmed she needed diuretics. The doc did an echo and he's like her ef is at 30%. But before they decided to admit us he decided to turn her pacemaker way down so her heart wouldn't pace. Her underlying is in the 50-55bpm. We did a repeat echo and it jumped to 40%. So they again talked about adding a lead. As of now her ef is somewhere between 45-50% which is good. They switched the pacemaker mode to ddi and put her low rate at 60. My question is how long could she go with her rate at 60 and be ok? The only thing we really notice is she tires easily and by the end of the day she looks like she's got a couple of shiners. Her eyes underneath are like dark dark purplish-black/gray. And being a kid I know she won't tell us if there's anything else bothering her, cause she doesn't want to go back to the hospital. Anyone have any ideas?

Thanks


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