CRT-D To be inserted in JUly

CRT-D?

by AgentX86 - 2018-05-24 22:05:30

I'm wondering why...

1. ...you're having a CRT-D pacemaker implanted?

2. ...if a CRT-D is really needed, why are they waiting, at least, six weeks?

Makes no sense, at least as stated.

What issues, besides heart failure, are you experiencing?

Thanks Robin1

by Cragzop - 2018-05-24 23:20:20

Thanks for the extensive reply. My cardiologist is a Cornell trained, board certified, electrophysiologist, who interned at Cornell\Weill in NYC. She claims to have done hundreds of these. For what it's worth.
I was told I will be under a general and will need to stay overnight for observation.

Regards

AgentX86

by Cragzop - 2018-05-24 23:26:35

I experienced shortness of breath, and ended in ER with a BP of 170/90, pulse of 120, Catherdization found no blockage, but a LVEEF of 15% and a lbbb.
I had chemo for Hodgkin's lymphoma in 2008, and they suspect my heart was damaged by the doxorubicin.

The decision to put off the surgey until mid July was totally mine. My cardiologist suggested it be done within the next 3 weeks, but I have a number of personal tasks I need to get out of the way, before I get laid up recuperating.
Thanks

CRT-D?

by AgentX86 - 2018-05-24 23:56:17

I wasn't trying to denigrate your cardiologist (my cardiologist is great but I wouldn't let him do my pacemaker, though he does implants).  I'd see a good EP if anyone were even considering a pacemaker.  What you posted didn't indicate a CRT-D pacemaker to me.  The LBBB is a hint at something more serious, though.  Are you having pauses?  VFib? I guess they're worried about asystole from the LBBB? If a defibrillator is needed, I wouldn't think it would be safe to wait six or eight weeks.  They wanted to keep me in the hospital until they could do the job.  They got me in, in three days and I didn't need a defibrillator.

Your heart failure (20% LVEF) tells me that a CRT pacemaker is a good call but you haven't said anything that indicates, to me at least, that a defibrillator is needed (the -D part).  I would have guessed at CRT-P unit but they don't pay me to save lives.  ;-)

I guess what I'm saying is that you have some questions to ask.

I'm sorta surprised that they're going to use general anesthesia, too.  Mine was done with only locals.  One in the groin for the catheter and the other in the chest for the implant.  I guess the EP and I have gotten to know each other well enough that he doesn't have to use drugs to get his way with me. ;-)

AgentX86

by Cragzop - 2018-05-25 00:29:03

No worries. I did not take offense at your cardiologist comment, it is welcomed. As I posted, she is a board certified cardio electrophysiologist and has done hundreds of these.

That said, I did have reservations about the "D" component of the device. I think she wants it because of my tachycardia, if that makes sense. My pulse was over 120 when I went to the ER, so I guess she might be concerned. I am retired for the last 4 years, and have done NO exercise, where when I was working I did a huge amount of walking. I wondered if I started exercising again if I could get my lvef higher, but she explained that my numbers didn't change after 3 months of meds, so she doesn't think a cardio workout would improve things, though she did want me to start cardio rehab at the hospital.

That said, I did ask her if the defib could be deactivated, because I have heard stories of people being jolted doing various activities. She said not to worry as she would program the device to kick in if my pulse goes to over 200. She said she has a number of teenagers who use the device, and she knows that they drink (raising pulse,) and dance at parties, so she has programmed according to lifestyle.
If I get too concerned about getting shocked, I might ask to disable it. As she put it, it is easier to put in a CRT-D and not need it, than to put in a CRT-P and one day need the defib component.

Thanks for the follow up. Please feel free to respond with anything you feel is relevant. This is my life we're talking about here, and I truly appreciate any input from those with experience since I am aprehensive.

Thanks

pretty simple

by The real Patch - 2018-05-25 13:32:34

why do you need a defibrillator...pretty simple, patients with a low ejection fraction (30% or lower) are at much higher risk of fatal ryhthms such as Ventricular Fibrillation and/or sudden cardiac arrest. Most Cardiologists (which EPs are) will automatically prescribe a defibrillator under this situation. The CRT is of course to treat the Left Bundle Branch Block and synchronizes the right and left ventricles so they beat simultaneously and strengthen heart beat hopefully increasing the ejection fraction.

What you might consider is having them insert the little known fourth lead to treat a low Ejaculation Fraction. It's quite common for male patients to experience that issue due to low blood flow and BP meds exacerbate the problem. My wife calls it assault with a dead weapon.

I do think it risky to wait, few people survive V-Fib or SCA without intervention and you don't get a warning it's coming. Mine have struck out of the blue.

One final note, while everyone else touts getting the very best doctors, I disagree. Mine graduaqted at the bottom of his class. I don't expect much and he delivers. Something to be said about reliability