biventricular pacemaker replacing 1 year old pacer?

We Know It’s a Lot

by NiceNiecey - 2018-09-14 20:00:12

Hello Mrs. McGrew!

It sounds like you’ve got a lot on your plate and someone else will be able to help you more than me HOWEVER I want to encourage you!

1.  55% Ejection Fraction is fabulous!

2. Getting a third lead is not uncommon and it will help him. It’s known as a CRT or Cardiac Resynchronization Therapy. I was told to expect that at some point, too.

3. Lead a healthy life - free of smoking, weight under control, eating good food, exercising (even if it’s just walking).

You sound like a great wife.  I’m sure this is a horrible shock for all of you but keep after Mr. McGrew and try to make it to these early appointments when it’s all so new.  Keep praying!  God listens!

Niecey

S

by Mcgrewcrew4 - 2018-09-14 21:11:45

Thank you for responding, Neicey. I have a lot of anxiety over this because we have 2 boys and they need their daddy! Do you know if they add the lead to the current pacer? I’m just confused as to everything I’m reading 

Not Sure

by NiceNiecey - 2018-09-14 23:16:06

Hello Again, Mrs. McGrew!

I can certainly understand the anxiety - especially with children at home. 

Although I am not positive, I believe they do add the 3rd lead to the current pacemaker device.  Now if it's time for a new PM, they would do it all at once.  If it's not time for a new device, the physician would simply add the 3rd lead via the existing PM.  

I would certainly ask lots of questions and even get a second opinion.  It doesn't mean you don't "believe" the doctor.  It just means you want to confirm what he/she is suggesting and perhaps learn along the way that you communicate better with one doctor over the other.

I'm going to be frank: somebody is sure to mention an ICD (implantable cardioverter defibrillator).  Just research ahead of time so you're not having to learn all of this at once!  The Cleveland Clinic is know for it's excellence in all things related to the heart and I suggest it's a good online place to learn.

The good news is that Mr. McGrew's EF is really great.  Make sure that number is accurate because from what I've read, a CRT isn't usually necessary with an EF that high.

Have a great weekend!

New lead

by AgentX86 - 2018-09-14 23:53:06

A LVEF of 55% is very good (normal/perfect is 60-65%).  55% certainly isn't a reason to go to a CRT pacemaker (right ventricle lead) but it's a good idea anyway.  It should have been done off the bat, IMO.

A few comments:  "Sick Sinus Syndrome" is the most common reason for Bradycardia so it's unlikely to be something new.  It was almost certainly the original problem. The AV block is the reason he has the second lead and they should have put the third in at the same time.

As far as adding the third lead, I doubt that's possible without a new pacemaker because it's unlikely they implanted a CRT pacemaker if they weren't going to use the third wire but maybe.  Your husband should know the model number of his pacemaker.  You can look it up the manual on the pacemaker and see if it is a CRT-P device.  It's not that big of a deal to swap out a new pacemaker, too, but they aren't free.

Oh, and my wife would never let me go to a cardiologist or EP appointment without her.  It's quite helpful because a second set of ears is always good. Anything discussed is rather important to the both of us, so it's only reasonable for her to go.

devices

by Tracey_E - 2018-09-15 09:57:44

If he has a two lead device, they would replace it with a new device that can support the 3rd lead, then use the two existing leads and add a third one. So he'd be getting one new lead and a new box.  Low EF is a reason to switch, but his EF is good. I don't know much about pulmonary hypertension, will the third lead help with that?? If not, I don't know that I'd be in any hurry to do it. I'd get another opinion before proceeding for sure, consider waiting until the current device needs replaced rather than have an extra surgery.  

When we are ventricularly paced, our ventricles are not synced so that's not news and everyone paced for av block shows that in an echo.  Some deal with it just fine for years, others do better with the third lead. I've been 100% paced since 1994 and my ef hasn't changed. My old cardiologist suggested switching me to a 3rd lead when I got my 5th pacer a few years ago. I'm active and without symptoms and I don't have room for another lead on the left side which would have complicated things, so I decided not to mess with it until one of those things happened. I switched to another ep who said no way, he didn't think a 3rd lead would be beneficial for me now, probably not in the future. The new doc is a congenital specialist so sees lots of others like me who have been paced long term. While I adored my old cardiologist and don't hesitate to recommend him, I don't think he was the right doc for me because he didn't have other patients like me. So that's where I would go next for your husband, find an ep that has a lot of other younger patients, active patients, long term paced patients. I found mine through the Adult Congenital Heart Association, his practice is in a large research hospital and sees 1000+ patients. I travel to get there but it's just once a year so well worth it for the additional expertise.

3 wire pacemaker.

by fisherguy - 2018-09-15 16:41:48

I had a 3 wire pacemaker installed in July. It was only 3 years after my first pacemaker. My oxygen levels have gone up nicely that my heart beats in sync. He will see improvement with the 3 wire. I am so thankful for the new pacemaker and feel your husband will be also for his.

Hi TracyE

by AgentX86 - 2018-09-15 22:30:15

Can you clarify this sentence, please? I'm not understanding your point.

"When we are ventricularly paced, our ventricles are not synced so that's not news and everyone paced for av block shows that in an echo."

By "ventricularly paced", do you mean only in the ventricles?  That is, not even sensing the RA?  Why would this happen to someone with three leads? Not everyone with AV block is AV dyssynchronous.  In fact, I'd expect it to be rather rare. I'm one of those who is AV dyssynchronous (only have two leads -LV and RV) but because my atria are in constant flutter, there is no point in connecting them and if they did, I'd be right back where I was before the AV ablation.

Thank you!

agentx

by Tracey_E - 2018-09-16 09:52:24

I was referring to those of us with av block with one atrial and one ventricular lead who primarily pace ventricle only. 

Two chamber pacemaker

by AgentX86 - 2018-09-16 15:31:09

I still don't understand. Even if you're pacing in the ventricles only, the pacemaker is still sensing the atrial beat. So AV sync is maintained. The problem of dyssynchrony comes in if the atria's beat is unreliable,  so is ignored by the pacemaker.

CRT Justification

by donr - 2018-09-16 18:39:48

My EF dropped to 40% - I was running at better than 70% severl yrs ago.  (I know - that sounds a bit optimistic, but I read it in a report a few days ago.)  I asked my local EP the griteria for the CRT-D & he said it was 35%, I believe - anyway, less than where I am right now! That's according to some NY state standard that is used prettyb much world wide.  Now that may be the criterion using EF for a basis.  Throw in pure poor sync problems & it may change.  Try Gr. Google for the NYHA (New York heart ASSOCIAtion) criterionfor a CRT-D to read the details..  Hopefully, Grateful Heart may stop by - I think she is the hostess for a 3 wire job.

To add to others - the CRT-D is a whole new ballgame - the computer runs on a different set of math algorithms & the lead commections will not support adding a third wire to the case.

Donr

LVEF

by AgentX86 - 2018-09-16 19:50:00

I've heard those restrictions on CRT pacemakers before but I have a CRT-P, with an LVEF of 65%. Maybe it's because I'm dependent? Safety factor?

I read the WHOLE study

by donr - 2018-09-17 01:03:49

 supporting the NYHA criteria.  Like Uranium - really heavy stuff.   Here's what I foumd most of the way through it:  "As best results were achieved if CRT pacing rate was continuous, atrioventricular junction ablation adjunctive to CRT showed a potential benefit and appeared to be superior to medical heart rate control in atrial fibrillation patients,"

.Otherwise it appears that generally speaking you have to have the 35% EF and/or a wide QRS complex.

Donr

Donr

by AgentX86 - 2018-09-17 09:44:52

Well, that answers my question. ;-)  I've been wondering about the difference but hadn't run across that distinction.

Thanks.