Ejection Fraction

I had a Pacer put in November of 2013. Everything seem fine until recently. I had a little trouble doing real strenuous things. No pain just a strange feeling. My Heart Doc had me do a chemical stress test and it has been determined that my Ejection Fraction went from 55 which is ideal to 40 after the pm which is low. Has anyone ever heard of this? Is it coincidence?
Dan

2 Comments

Well known

by golden_snitch - 2014-06-04 01:06:40

Hi!

It is, in fact, a well known complication from right ventricular pacing. The problem is that, if you pace only the right ventricle, it might pump a little earlier than the left ventricle. The ventricles beat out of sync, and that causes the EF to drop. It has been observed so often, that pacemaker manufacturers and cardios alike are working on this problem. The manufacturers have designed special pacemaker modes/features that reduce the amount of ventricular pacing to an absolute minimum -- in those patients who do not need it all the time (if you have a permanent complete heart block, you need to be paced 100% ventricularly). The cardios, on the other hand, are testing different sites for pacing as they believe that it's the right ventricular apical pacing that is the problem.

I read that you have a type 2 heart block. I guess, you mean second degree? Or do you mean second degree, type 2? Anyways, that is usually an intermittent block, so you should not need to be paced in the ventricle 100%. If you are, then your cardio should optimize your settings, so that you are paced less. This can be done, for instance, by prolonging the AV-delay --> the time the AV-node gets to do the job on its own.

What is also an option is to put in a bi-ventricular pacemaker, that paces both ventricles, and not just the right one. Thereby, the synchroneous pumping of the ventricles is restored.

Hope this helps. Best wishes!
Inga

Myocardial Perfusion Scan

by Dan1969 - 2014-06-05 01:06:02

Hi Inga -Thank you, very interesting insight. As they described it the lower portion of my heart is paced at nearly 100 percent of the time. The electric impulse is slow at getting there.
The doctor also told me that I have a minimal non reversible inferior perfusion defect and he wanted to do a artery catherization. I was hoping to get more info before going through with it.
It seems that they do not want to alter any settings.
Thoughts??
Dan

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