Scheduled dual chamber pacemaker implant 8/16/2016

av block?

by Tracey_E - 2016-08-08 10:05:48

By blockage do mean av block? As opposed to a blocked artery, which is a plumbing issue and not treated with a pacemaker. Assuming it's av block, do you know what degree it is? 1st is not treated, 2nd is occasionally treated, 3rd is eventually treated but they usually wait until we have symptoms. If you have no symptoms, you will feel the same after. I found out after that I had more symptoms than I thought I did. I lost stamina and got dizzy more often, but it happened so gradually that I didn't realize how bad it was until after when I felt normal again. But I did have symptoms! I tired easily, was dizzy more often than not. 

Why do it now if you have no symptoms?

Stage 2 AV blockage

by Ijt1948 - 2016-08-08 11:07:56

Thanks Tracy, I do have stage 2 AV blockage, and I had the same concern you touched on, which is why not wait until I have symptoms. I've had a second opinion and both doctors recommend the pm now, saying my condition will only progress and passing out is a possibility, and under the wrong circumstances, could be fatal. The halter results were 1132 pauses in the 24 hr period over 2 sec and one at 2.7 sec, heart rate low at 36bpm, and average hb at 58. 

I just joined the group yesterday and have been reading posts and gathered that many of you are very knowledgeable, which is great for someone new like myself, and would appreciate any comments or recommendations.

gray area

by Tracey_E - 2016-08-08 14:28:44

Most of us are amateurs who have been around the block a few times. I learned early on that I'm rare in a cardiologist's office, my gp has a decent idea what's going on with my heart, for any other specialists av block was an afternoon in med school and they are mostly clueless. So, it pays to be informed, to be able to explain it. I've always  had doctors and techs who are great about explaining things to me and letting me be an active participant in my care. My first cardiologist appointment was in 1970, so I've had a few years to play 20 questions with the staff :)

Sometimes we clearly need it, other times we clearly don't. Unfortunately everything in between is judgment call. Some doctors are more conservative than others. Have you seen an ep yet or just regular cardiologists? I haven't been to med school so don't take my opinion over two doctors, but your numbers aren't awful. If you haven't seen an ep yet, I'd do that for sure before scheduling surgery. 

With block, our atria generally works the way it should and goes up and down on exertion. Block means the signal doesn't  make it to the venticles so the pulse drops off. Second degree can either mean sometimes all of the signal doesn't get through and the ventricles beat at random, or partial signal goes through all of the time so your rate goes up, but not as much as it should because some beats are missed. It can be fluid, so sometimes we beat normally, sometimes nothing gets through, sometimes some of the signal gets through. It is common to get worse over time but it's very very rarely fatal. 

Under 60 is considered bradycardia. Most people do fine in the 50's, some do ok in the 40's but once you're consistently in the 40's or below that, it's time to be paced. My block is 3rd degree and congenital so my rate never went above 44. I never knew any different and when we're young the body can compensate so I got by just fine until my 20's. My doctors were the opposite of yours, they didn't want to pace someone young so they waited and waited. My rate dropped to the 30's over about a year then tanked one day and was 22 when I was admitted for emergency surgery. I was in danger at that point but oddly enough I never passed out. That was not the easy way to do it, better to pick a date, discuss things with your surgeon and plan it. 

Passing out is a serious risk, esp if you have pauses. Unless you have a crystal ball to predict when it will happen, you want to be paced before you are at risk of passing out. We've had members pass out behind the wheel then end up recovering from both the car accident and pacer implant. Not cool. However! Pauses have to be a whole lot longer than 2-3 seconds before you are at risk of passing out. I forget what the official criterea is but it's something like 6 or 7 seconds. Under that is not considered significant, tho 1300+ is a a LOT of pauses. 

Odds are you will need it eventually so it's a judgment call whether to do it now or wait. I wish I'd had mine a lot sooner than I did. I was regularly monitored but deteriorated so gradually that I had no idea how bad I really felt until I woke up with a normal heart rate.  If you decide to do it now, you may not feel any different after but you'll know you are safer. Or, you may find that, like me, you don't feel quite as well as you think you do and your energy goes up. If you are pausing a lot, if you are dipping down at night, if you exert but your rate doesn't go up accordingly, all of that is stress on the body and a pacer will relieve that stress and give you more energy. 

If you have questions about the surgery or recovery, or just want to chat. don't be shy. 

Seen the EP

by Ijt1948 - 2016-08-08 19:59:11

He also suggested it's time for the same reason. Do you know if I have a say on how my pm is monitored, or any suggestions for questions before surgery? 

questions

by Tracey_E - 2016-08-09 10:53:29

Every doctor has his/her own protocol for follow up. Some want to see us as often as quarterly, some as little as once a year. Most of them have home monitors now which means fewer trips. I used to go every 3 months but my newest one has a home monitor so after the few two office checks, now I don't have to go back for a year. I felt like this was an invasion of privacy and I don't like having a reminder in my face every morning that my heart is wonky so I was a little upset by the box at first. Then I wrapped it in a towel and shoved it under the bed and forgot about it. It does a check in every night and a big download every 3 months. If something weird happens, I can push a button and send a download, then call/email to tell them to watch for it.  I just did this for the first time two weeks ago, emailed a few times with my doc and figured out what was going on with no office visit or dragging the SJM rep in to see me. So now I'm a convert and I think the  box is kinda cool. 

Av block is the easiest condition to fix with pacing because our sinus node (our natural pacemaker) works normally so all the pacer is doing is playing follow the leader, making sure the ventricles stay in sync with the atria. This means any of them will do the job so don't stress over what kind you'll get. Also, they are all pretty darned small now so don't worry about getting a big honking thing. If you ask, they can show it to you before. 

The main thing I would talk to the surgeon about in advance is placement. Many of them do it just under the collarbone just under the skin. Fast and easy and it heals quickly. However, depending on our build it can stick out and if you are active it might get in the way. They can do it a little lower and deeper so it's out of the way. Mine is more extreme than that,it's under the pectoral. Longer healing, but imo well worth it in the end.