2 leads vs 3 leads for a 42 year healthy female

I'm a 42 yr old female in complete heart block since Nov 12 after an ablation for SVT. I'm in need of a pacemaker - I have been told by 3 different Dr's that they would suggest a bi-ventricular pacemaker with 3 leads...from what I understand they believe that this 3rd lead will prevent heart failure long-term - since I will be using the pacer at all times...they want both sides of the heart pacing the same.

And I have 1 Dr who said to do the Dual pacemaker and just use 2 leads - believing that it is more risky to have more leads than necessary..and he has a colleague who does studies on this very decision in younger people - who also strongly disagrees with putting a 3rd lead in....I'm young and healthy - and he doesn't think my chances of heart failure are severe enough to put that 3rd lead in now... especially with an ejection fraction of 70%....it could be added later if necessary...

Have any of you come across this issue or know any resources where I can get more clear on what would be best for me?

6 Comments

Dual-chamber is perfectly fine

by golden_snitch - 2014-12-23 01:12:35

Hi!

There is absolutely no data supporting the prophylactic placement of CRTs (bi-ventricular pacers) in patients whose EF is not reduced. On the contrary, if you google "Biopace trial" you'll find data suggesting that it is of no benefit, and that a dual-chamber pacemaker is sufficient in patients with heart block, but without decreased left ventricular function. Also, as far as I know, many insurances do not cover a CRT device, unless your EF is 40% or below. What the three doctors are suggesting is not in accordance to any guidelines published on the indication for CRT placement.

The majority of patients who are paced 100% in the right ventricle does not develop heart failure or Afib. Yes, the number that does is still signifcant, but it's really not that every second or third or so patient suffers from this side effect. So, it's safe to just wait and see what happens. I'm paced 100% ventricles and atria, and we just keep an eye on my EF by doing echos regularly. A third lead can still be added, if necessary. And also keep in mind that leads can cause issues, too, like stenosis/thrombosis. And replacement of broken leads is not that easy. Being 42 you might need to have leads replaced, and with three leads already in, they'd probably have to remove old leads to make space for new. Putting in three leads for a condition that normally needs only one lead pacing is irresponsible, in my opinion. And again, there is NO data showing any benefit.

Seems like those three doctors are not up to date, do not act in accordance with AHA guidelines, and maybe just want to make more money because CRT devices cost MUCH more than dual-chamber pacemakers and the implant procedure is more tricky and takes more time.

Inga

in the same boat

by water - 2014-12-23 03:12:11

Hi Lisa, I am 36 and am in the exact same situation as you. I agree with golden as my cardin said there is no point putting in a 3 lead now as it might cause more complications. But my pacer was installed 4 weeks ago. So kwe in touch you are not the only one with this problem.

2 is plenty

by Tracey_E - 2014-12-23 09:12:08

Unless EF is low, there's no reason to do 3 lead. It's not commonly done and as Inga said, studies show we don't necessarily do better with the extra lead. There are still some minimalist old-school drs who only do one lead for av block.

3 lead?

by Selwyn - 2014-12-23 12:12:43

Totally against NICE guidelines here in the UK. I agree with golden_snitch and water. If you have no heart failure, you do not need a 3rd lead. There is every good reason to use 2 leads based on outcome evidence which I discussed a couple of weeks ago ([search])


www.nice.org.uk/guidance/ta88

wow! Please keep the comments coming!

by lisabfit - 2014-12-24 02:12:59

Thank you all for your input -

'I'm in complete shock that all 3 of these Dr's NEVER even mentioned or suggested that a 2 lead was an option for me...It was literally Dr #4 who said he thought 2 leads was the best option - and that he would ABSOLUTELY NOT recommend the 3rd lead...
I've been so confused - 3 against 1 - it seems like I should go with the most "votes"...but after hearing all of you - I realize - this needs further investigation.

My plan now is to have all the Dr's "pow-wow" - take another look at my case and explain WHY and IF they still feel STRONGLY about putting in that 3rd lead - or if they are willing to admit that 2 leads will do the job...

thank you again - this is an amazing forum and I'm so grateful to have come upon it

third lead

by SamanthaS - 2019-11-11 13:26:10

so these comments are all fairly old and I wondered if anyone has new thoughts on this.  I'm 12 months out and my EF is now a bit low.  Cardiologist and EP both had mentioned to me the possibility of a different pacemaker with 3 leads versus the 2 leads I have now.  No real details yet as waiting on labs.  I would, of course, rather not go through this yet again so soon.

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