crt

Dear friends,
I have pacemaker for 10 years and now battery life is going to expire. I have atrial lead and ventricular in the apex of right ventricle. My usual rhythm is AV sequentional pacing. I am not happy with pacing, after implantation my physical performance dropped by 20- 30%. My hope is that biventricular pacing can improve my physical ability. However, there is a problem: my cephalic vein seems to be occluded and there is a problem to place an additional lead to great cardiac vein.
Any idea to solve this problem?
Yours, Mat

4 Comments

adding a third lead

by mhorvat - 2014-01-26 01:01:20

Dear Inga,
Thank you for your very experinced comments. Really, I have my EF between 45 and 50. Anyway, my physical performance dropped significantly after placement of pacemaker 10 years ago. On several occasions, after emotional and physical stress, I went to pulmonary oedema with reddy sputum and severe dyspnea. Majority of attacs subsided after rest and vein tourniquets. Echo showed pronounced dissynchrony of ventricles. Situation little better after medication with perindoprile.
Changing site of whole system means that I will have at least 5 electrodes in my heart.
Subclavian vein is a good idea, maybe epicardial lead too. Must addmit that I was very active my whole life, finished 5 Ironman. Some literature proved that CRT is helpful even if EF is only slightly depressed. Consideration of change in pacemaker system is actual now, because battery life in my pacemaker is going to an end and I have to have op anyway.
Yours,
Mat

CRT

by golden_snitch - 2014-01-26 02:01:10

Hi Mat,

if you have a wide QRS-complex, you might benefit. If not, very recent research has shown that a CRT device can cause more harm than do good:

http://www.medpagetoday.com/MeetingCoverage/ESC/41338

But if you have this severe dissynchrony, you might really benefit from a CRT. I was just under the impression that some insurance companies or health care systems don't pay for it, if your EF hasn't dropped significantly. I have heard/read somewhere that the EF needs to be less than 40% before you can get a CRT, but that was probably in the U.S. or in the UK's NHS. Surely differs from country to country. Don't know what the regulations are in Slovenia.

Good luck!

Inga

CRT

by mhorvat - 2014-01-26 04:01:49

Hi Inga,
Your comments were very helpful. Of course, I wouldn't cosider the use of CRT in case of normal QRS.
Good night,

Mat

Adding a third lead

by golden_snitch - 2014-01-26 06:01:32

Hi Mat!

First question would be: Has your EF dropped, too, or is it rather that your physical performance has worsened, but the heart is showing no signs of failure? It does sound like you are experiencing pacemaker-related heart failure. I was just wondering about your EF, because the bi-ventricular pacemaker will probably be no option, if your EF hasn't dropped.

The lead could be placed via subclavian vein. Or you move the whole system to the other side where the veins are still good. Or you can have the left ventricular lead placed as an epicardial lead. That would be a more invasive surgery, but it's not an open-heart surgery, just a lateral mini-thoracotomy (and I believe some clinics are able to do this via keyhole surgery).

Best wishes
Inga

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