Function of third lead

Hi All,

I am posting for my dad. He is 60 years old. Had a pacemaker (ICD)surgery in March 2016. His Ejection Fraction was dropped to 10-15%, thats why doctor suggested to get a pacemaker installed. After having pacemaker for 6 months, when his Ejection Fraction was tested again, its just 25%.

I would like to provide few more details here. I would really appreciate your help in deciding whether what our cardiologist is doing is right.

Cardiologist said surgery will take 45 mins, but actual surgery took 6 hours! He said he had complications while placing third lead. He called other cardiologists during surgery and they were able to place the third lead, according to him. However during our recent visit to him (12/23/2016) he mentioned "third lead has some issues, there is no point in reoperating the patient". I was shocked by his statement and missed asking what problem is there exactly. I am going to ask him in next visit.

My questions is what is the use of third lead? What functionality my dad is missing by not having third lead? Just having 2 leads are enough for my dad? Currently my dad is suffering from short of breath after walk, or while doing minor chores. Also he is having headaches, arm pain. What all questions should I ask to cardiologist to get correct information about what is working and what is not working, and my dad's condition.

I am just worried about my dad's health, after spending soo much money, time, efforts and lot of mental stress. I would really appriciate your help.

Thank you very much for your help!

-Swati Thorve


5 Comments

Third lead

by IAN MC - 2017-01-02 06:37:36

The cardiologist will have had very good reasons for fitting your father with a 3rd lead .  Fitting a 3rd lead is not easy and can take several hours because of the complex mapping of the various cardiac veins . It is not always successful at the first attempt even in  the most skilled hands.

Why a 3rd lead ?  The probable explanation is :- 

 Because your father's two lower heart chambers ( the right and left ventricles ) must be beating out of sync . If they do not contract at the right time then the heart cannot meet the demands of the body and symptoms of "heart failure" develop . In simple terms it would cause each of your father's individual heart-beats to not pump enough blood round his body.

This would account for his poor exercise tolerance and breathlessness. Having the 3rd lead put in his left ventricle should have helped with this problem but life isn't always that easy.

You need to communicate with the cardiologist and establish exactly what  the current status of his 3rd lead is . Equally importantly you need to ask whether  his present health is as good as it gets and , if not, agree a future course of action.

Best of luck

Ian

As Ian Said

by Good Dog - 2017-01-02 07:44:00

I certainly don't claim to know much about it, but here is my understanding:

The likely purpose of the 3rd lead is for Cardiac Resynchronisation Therapy. This will help with the symptoms as Ian indicated. Additionally though, it is intended to serve to reverse his EF numbers and increase them. That is good.

However, As Ian said, you really need to communicate with the doc in an effort to confirm all of this.

love the third lead

by alicia6650 - 2017-01-02 22:17:06

Basically, the third lead allows the top of your heart to communicate with the bottom of your heart.

I have a complicated history and case, including MANY ablations, MULTIPLE device surgeries and upgrades, and three open heart surgeries. I have heart failure and when I got upgraded to my CRT-ICD, it made a HUGE change for me. And (i just wrote this in reply to another post!) the more leads in the heart, the more options that doctors have for device settings. With any pacemaker there are tons of options. But with that additional lead, they not only multiply the timing options (of when the bottom of the heart answers the beat of the top) but they are also able to see what another chamber of your fathers heart is doing, which is fantastic for treatment.

I'm pro 3rd lead...all day, every day. =) Good luck!

third lead soon

by dwelch - 2017-03-14 00:55:59

Going to get a three lead in the next few weeks.  30 years of two lead pacemakers and my EF has finally gotten too low and three lead pacers are now a thing.  The heart normally paces from the middle out the ventricles hit at the same time.  But with a two lead pacer it is not pacing the ventricles from the middle but from one side (the one easier to get a lead into I understand now, or maybe I dont understand and just assume) which makes the ventricles beat unevenly.

if the low EF is from the two lead, then a three lead should help, if the low EF is from something else, then that is perhaps why it is an ICD (which are also pacers), get the doc to answer your questions or find one who will.

 

 

 

The Third

by Ef25 - 2017-09-07 14:41:22

They use the third lead if you have cardiac dysynchrony. Usually if your lower chambers ( Left and Right Ventricles) do not beat in unison. such as a Left bundle branch block. The heart is not as effecient when one ventricle squeeze later than the other. 

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