Update to 2013-09-15 Post

• by rdman
• 2015-04-12 10:04:12
• General Posting
• 961 views
• 2 comments

(To further clarify my 2113-09-15 post, the RF ablation for the intermittent atrial flutter that was performed in 2009 also resulted in an apparent over-burn 1st degree AV Block.)

Subsequent to my 2013-09-15 post, one year later, I again mentioned the Boston Scientific pacemaker (BS) with Minute Ventilator (MV) sensor to my E/P. Since he had poo-pooed it in 2013, I was very surprised when he now enthusiastically endorsed the MV sensor feature for my active life and agreed to schedule a pacemaker exchange during the following month.

Since I felt very good with the Medtronic Adapta (except that I could not attain a heart rate to match my rigorous bicycle rides without banging-on-the-can), at this point, I asked a number of questions including - did the BS algorithms match the Medtronic Managed Ventricle Pacing (MVP). The E/P stated that BS was virtually the same. Satisfied that the BS pacer would mimic the Medronic including their MVP algorithm, the BS pacemaker implant date was set.

Following the BS implant and initial settings, I felt lousy - chest pressure and discomfort, throat sensations, PMT, PVCs, palpitations. Thinking these symptoms would resolve with further tweaking, I went through at least six comprehensive adjustments with senior technicians without significant improvement. It was during these adjustments when an very knowledgeable, independent pacemaker technician informed me that virtually the same is not the same thing as identical, explaining that BS methodology to pace the ventricle only when necessary is very different from the Medtronic patented, proprietary MVP. While the Medtronic was pacing at about 10%, the BS was now pacing the ventricle at 40% more.

During subsequent consults with the E/P, he agreed to remove the BS pacer after just four months and re-implant another Medtronic Adapta with MVP (four pacemaker implants within the last six years). However, at virtually the 11th hour while I was in surgery-prep, the E/P informed me that he was going to conduct an E/P mapping study instead of more guess-work!

After the five-hour mapping procedure, the E/P informed me while I was still foggy from sedation, then later when I was clear-headed, that the mapping study had revealed retrograde circuits in and around the AV node and dis-synchrony between the right and left ventricles. He proposed the following:

* He would attempt to ablate the source of the aberrant circuits within the AV node utilizing the cryogenic method which is more precise and forgiving than the RF method.

* Since he felt it was a long-shot to isolate the exact sweet spot on/in the AV node, the only other option would be to completely ablate the AV node which would result in total pacemaker dependency.

* If total dependency would result, a Medtronic CRT-P, 3-wire would be implanted. A 3rd lead, which was described as a very fine, thin wire, would also be attached on the right ventricle septum wall near the ablated AV node.

Aside from not fully understanding how this array works and having a very difficult time mentally having to go totally depend as apparently the last option, I have several other concerns.

* The original St. Jude leads are going on six years old. About a year ago, I was informed that the ventricle lead had slightly backed out of its attachment requiring signal strength adjustments. The recent mapping study revealed that this lead is not optimal.

With the advent of the Spectranetic power laser sheath that now provides safe extraction of old leads, would it not be good practice to remove these old, non-optimal leads and replace them with new leads?? This procedure is relatively new and requires highly skilled experience.

* The cryogenic ablation method also requires highly skilled experience. I have been informed that as of a month ago, my E/P has used the cryogenic method just one time.

I would be very appreciative and thankful for all members who wish to offer counsel, advice and support. Is total dependency my last option??? Thank you all!!