CRT-D or CRT-P

Ty

by Ef25 - 2017-08-14 07:32:48

Thanks Robin1,  my doctor told me the same thing. I might not ever need that ICD but all it takes is that one time I need it and it is there. Guess I am just worried about how they have to induce a cardiac arrest to test if the CRT-D is working properly. I'm not too scared about the procedure itself but more worried about the " what if" during testing right after. 

None of us wanted a device

by Grateful Heart - 2017-08-14 11:18:06

My EF ws 24%.  I was also diagnosed with Idiopathic Cardiomyopathy, no blockages...SSS, LBBB.  That was 9 years ago.   I still have the original device which paces me 100% and have never been shocked.  I joke with my husband that I probably have a defective one.  :)

You won't remember the testing and if something did go wrong, the hospital setting with your doctor and all the life saving equipment is the place to be.  The implant doctor should be an EP who has implanted hundreds of devices.          

You can drive yourself crazy with all the possible "What If's" in life, there are no guarantees.  Hopefully you have trust in your doctor and can ask him questions.  Of course, you can always ask on this site too.

Forgot to add:  While everyone has different results....My EF is now 55%, I exercise more than I have in 30 years, lost weight and feel so much better.  Good luck.

Grateful Heart

Thanks

by Ef25 - 2017-08-14 11:42:41

Hoping for the same outcome as you. Actually when I went to get my angiogram something happened which brought me back to normal sinus rhythm post procedure. I felt great for 3 weeks then found out last week from my pcp that my LBBB is back.  Thank you though. I havnt met the EP but my interventionist reffered me to him. He seems to have excellent credentials. 

Another option: HIS-bundle pacing

by Gotrhythm - 2017-08-14 14:43:56

I understand your reluctance to mess with a heart that appears to be working, even if atypically, in order to prevent a problem that might never happen. Your hesitation seems reasonable to me. You certainly would want to explore all your options before chancing a prodedure where 30-35% do not improve, and some worsen.

There is an alternative to CRT that is less likely to produce the "bad" effects sometimes seen with CRT. It's called HIS-bundle pacing. Instead of three electrodes of the CRT, one electrode is positioned at the HIS bundle. What's good about HIS-bunlde pacing for LBBB is that, instead of routing the electrical signal around the block, it deals with the block close to where it is occuring. The effect is more like a normal heartbeat.

HIS-bundle pacing offers significantly better outcomes than CRT. It's not available everywhere because the surgeon must have special training, but its use is spreading. Check out this article. (You'll have to copy and paste.)

http://www.medscape.com/viewarticle/844740

Depeneding on where you live, the downside to HIS-bundle pacing is that you might need to travel to a hospital where the procedure is done. 

In your shoes, in addition to an EP who does CRT,  I would want to consult an EP who specializes in HIS-bundle pacing before I made a final choice.

CRT-D

by marineboy - 2017-08-15 03:02:36

Two years ago had MI, LBBB, SSS, subsequent 4 stents and cardio rehab.

At time EF was 20-25%. CRT-D fitted in Singapore 5 months later, with immediate improvement.

A year on and my fitness greately improved and latest echo showed EF now 50-55%.

After two years still have periods of anxiety re any slight change in feelings in chest and thoughts of shock but pleased to say never been shocked and the anxiety does fade over time.

On another note I understand that with the constant improvements in devices some administrations now advice not testing the defib 'in situ' as there appears to be little advantage in doing so. Seems a little strange to me but as 'Grateful Heart' says if they are going to test you are in the right place! 

Best for the future

Thank you guys

by Ef25 - 2017-08-15 04:22:24

everything seems reassuring. The EP I was recommended to is practicing here in Los Angeles California. He is a Harvard University graduate and Affiliated to some big hospitals in the area like Cedar Sinai Medical Center and Good Samaritan Hospital.  I feel like I'm in good hands. I just hate that feeling of anticipation and loosing a month of work although the hospital I work at does offer medical leave pay.  Now its just a waiting game since I am still on the waiting list to get a call back from the Dr's office. I gotta admit, I am loosing sleep over this and I feel like I am going crazy. 

How often do you change out device

by Ef25 - 2017-08-15 04:35:58

how long does CRT-D battery usually last? Im getting conflicting info online. Thanks again

questions

by The real Patch - 2017-08-15 12:29:15

Well let's see, how long does a CRT-D battery last?  - Let me start my answer by asking you a question...How long are you going to last ? You see the answer for both is the same, nobody knows. They can give you an average life expectancy but ultimately there are too many variables to really know the answer. For example, someone who is paced 100% will use up the battery faster than someone who is paced on demand (a small percentage). Additionally eacgh different make and model has different features that contribute to battery drain and so on. If you know what make and model they are going to implant you can go to the manufacturer's web site and check what they estimate but assuming 5 - 7 years is pretty close to the average.

Should you get a D (defibrillator) or P (Pacemaker) - With an EF equal to or below 30% you are at higher risk of sudden cardiac arrest and the Defibrillator model is prescribed as a safety feature. Less than 25% of patients survive a sudden cardiac arrest (SCA) without immediate intervention. Inappropriate shocks are mostly a thing of the past as they have improved the devices significantly and changed the way they are programmed so there are less rhythms that are misinterpreted causing shock. Additionally if you read enough reports of inappropriate shocks you'll find many are from patients who have a pacemaker...they can't get a Jesus Jolt.  The vast majority of patients never need a Jesus Jolt.

I'm not going to blow smoke up your skirt and tell you that you will get better and see improvement in your EF with a device, I didn't but it benefits in other ways. If you should decide not to get a CRT-D I would like to be first to ask for dibs on your golf clubs, unlikely you'll be needing them for long