Whither His-bundle pacing?

I spent the night in the hospital Wednesday being "observed" because I came into the ER complaining of chest pain lasting six hours. The pain was never severe ( around 5-6 on pain scale) and waxed and waned but never went away.

After lots and lots of blood tests I am assured I did not have a heart attack--not even a little one. Diagnosis: angina. Recommendation: go back to cardiologist. But I did talk to one cardiologist who suggested that I have "princess and pea syndrome," meaning I feel PVCs and other arrythmias and "interpret" them as pain. I concur, except I don't think any "interpretation" is involved. I think they are painful and the frequency and pain are getting worse.

Because of Pacemaker Induced Tachycardia, my ventirical lead was turned off in 2013. 

The cardiologist also explained how pacing in the artrium only might not be synchronizing perfectly with the heart overall. My EP shrugs off the possibliity of s different kind of pacemaker since my heart won't accept ventricle pacing at all.

My doctors here are wonderful and doing theirr best, but what I have is way out of the ordinary. I think I need to be evaluated at a major medical center. I have read of His-bundle pacing on this forum. I wonder if it might help and which hospitals in the US might be doing it?

Does anyone know?

Thanks.

 

7 Comments

His bundle pacing

by Terry - 2017-05-18 19:31:51

Patient empowerment is so important to optimizing your health. Unless you get involved with your future, you may not be able to avoid pacemaker induced heart failure, which one recent study suggests happens in 16% of patients in time. That's where His bundle pacing comes in. It is the only way to pace the ventricles in a natural, physiological manner, for paced patient morbidity reduction. You could to go to Mayo or Cleveland Clinic for His bundle pacing. There's a center of excellence in PA. Perhaps I can tell you who does it in your geographic location if you contact me at the contacts page of <www.His-pacing.org> "Contact Us" page. If you don't hear from me, feel free to write a private message here.

Terry

BHP

by BillH - 2017-05-18 20:47:11

I follow a number of cardiologist and EP's on Twitter.

The EP's just had their national meeting and bundle of his pacing was a very hot topic.

More and more are starting to do it.

Off the top of my head I know that there are doctors in Chicago, Indinia University, and Lousiville doing it.

PM induced tachycardia

by islandgirl - 2017-05-18 22:43:36

I have been paced for SSS for about 2 years.  My atrium is paced at 99.8% and ventrical about 2%.  I was upgraded from a PM to an ICD following a sudden cardiac arrest from ventricular arrhythmias.  I received the ICD about 7 months ago.  I have been feeling really badly over the past few months and also the ICD alerted the EP I was having heart failure.  After several tests the EP diagnosed me with PM mediated tachycardia.  Thankfully the heart failure resolved on its own after about 3 1/2 weeks.  The EP, using the interrogation computer and an ultrasound person specialized in cardiology spent about an hour sychronizing the pacing with my rhythm in the radiology dept. at the hospital. I have spoken to the EP since then and he said he can do a little more adjusting in the office when I go back and see him after 4 weeks.  It has helped me alot, but I am sitll having symptoms.  I am still getting a lot of PVCs and arrhythmias, and my heart is still too fast when I even walk, but I'm not short of breath any more just walking a short distance.  Still get lightheaded and very fatigued--but working through many of the symptoms now.  I'm sure my EP went to the meeting if it was heart rhythm society.  I am anxious to talk to him about bundle of his pacing.  

Pacing

by islandgirl - 2017-05-19 13:36:24

I am reading about HIS pacing, and it seems since I have SSS, and I have little ventricular pacing, so I am reading HIS pacing would not benefit me. 

Am I accurate with this interpretation?  

pain

by BOBJ - 2017-05-19 14:54:05

The extra or skipped beats that I used to get (before pm) hurt. I never had a cardiologist that did not tell me they should not hurt. But they did.

I have since then found a few people that tell me their's also used to hurt when the heart would stop and start back or skip.

But since I have received the crt-d all of that has stopped.

I do know that my heart attack hurt the same way but just worse. My doc said it was because of the blockage. Did they check you for placque?

The pain's the same

by Gotrhythm - 2017-05-22 14:55:18

Thanks for saying you had PVCs that hurt. I feel vindicated. It's also interesting to know that in your experience the pain is the same as a heart attack only not as severe.

I just love the Pacemaer Club. There's nowhere else to get the quality information and support that we find here. I'm deeply grateful to those who founded it and who take the time to moderate it.

PMT, HIS Bundle pacing

by Hoosier Daddy - 2017-11-26 03:53:43

HIS bundle pacing as it currently is described does not really overcome pacemaker mediated tachychardia. HIS pacing is intended to reduce the INTRAventricular dyssynchrony caused by the unnatural activation of the RV by an apically placed lead. What it can reduce is chronic pacemaker induced AFib as well as long term reduced cardiac output.

A more easily accomplished modification is with the sofware. The postventricular atrial refractory period - PVARP - is raised automatically in a proprietary algorithm from Medtronic called PMT Intervention. Other manufacturers very likely have similar anti-PMT algorithms. They don't completely prevent PMT from happening, but they terminate it quickly when it happens. 

By the way, one of the advantages of AAI pacing (pacing only in your upper chamber, with the ventricular pacing turned off) is that it preserves synchrony between the mechanics of your upper and lower heart chambers UNLESS you have a high grade AV block. Is a second or third degree block the reason your cardiologist said AAI is associated with dyssynchrony?

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