Leadless Pacemakers

Leadless pacemaker?

by AgentX86 - 2019-03-19 22:59:06

I don't understand a leadless pacemaker for a heart block.  Basically, a heart block is a disconnect between the atria and ventricles.  A two (or three) lead pacemaker can restore this electrical connection.  The Micra leadless pacemaker paces the right ventricle only (VVI) and can't know what the atria are doing.  The result would be AV dyssynchrony.  This isn't a horrible thing but it's to be avoided, if possible. Basically, the atria become useless (worse than, actually). I'd ask some serious questions the next time you see him.

Leadless pacemakers

by Theknotguy - 2019-03-19 23:46:12

All I've heard is from the Medtronic people.  Supposedly they were brought out in Europe.  Had good success and were made available to the US.  They haven't been out for that long so not too much information available.  They aren't for everyone.  I have a lot of problems with afib so they won't do everything I need.  So I don't qualify for one.  

The ones that fit inside the heart are supposed to last up to 15 years.  Never taken out.  If you need a second one they just add it to the heart.  Theoretically you'd get 45 years with three of them.  No one is sure what they would do at the end of 45 years.  

That's all the information I have.  
 

Leadless pacemaker?

by drew65 - 2019-03-19 23:49:58

AgentX86, I appreciate your reply. I'll definitely ask about that (AV dyssynchrony). I did have concerns about the two not being in sync, so to speak, which I believe is what I'm also living with currently, as my understanding is that only a junctional escape rhythm is pacing the lower part currently. I had read somewhere that single chamber pacing could result in issues (A-Fib, I think I had read). The EP had said that the leadless pacemaker would only act as a backup, with a rate set at 40 beats per minute (essentially just to kick in when needed to protect me from any symptomatic pauses I might experience to prevent me from passing out — in the event I were driving, etc.) A traditional pacemaker is still likely in the future, I think this was just proposed as a way to delay that for a little while given my age and yet still offer some protection from catastrophic pauses. Or at least that was my understanding of it.

Leadless pacemaker?

by AgentX86 - 2019-03-20 00:02:28

Hi Drew, what you say makes a lot of sense, though I still don't understand why they'd put off a two-lead pacemaker.  The problem with single ventricle pacing is "pacemaker induced cardiomyopathy".  I can't see how anything in the ventricles could cause atrial fibrillation but I guess cardiomyopathy will cause fibrosis (which is really the cause behind AF).

Yes, I'd want my EP to convince me that a single-chamber pacemaker is the right descision. Just delaying the inevitable isn't a good idea, IMO.

Leadless pacemaker?

by drew65 - 2019-03-20 00:10:25

Thanks AgentX86, another important item to bring up. I was not familiar with pacemaker induced cardiomyopathy. I will definitely bring that up in discussion regarding single chamber vs a dual lead pacemaker. Thanks for the input and advice.

Pacemaker induced cardiomyopathy

by AgentX86 - 2019-03-20 08:53:12

Don't be too concerned about PIC. Only a small percentage of people with single ventricle leads get it. The Micra can't be used for it and if you're in the unlucky bunch,  you'll end up with a more conventional pacemaker anyway. I'd be more concerned about AV dyssynchrony with V-only pacing and heart block.

Bottom line is that I (not a doctor) don't see the Micra as being the right solution, in this case. I'd certainly listen to what my EP said, though.

"Trust but verify" - words to live by.

traditional

by dwelch - 2019-03-21 02:49:04

from what I am reading from these other folks a leadless which makes no sense at all for heart block, sounds like a really bad idea....for anyone....

I have complete heart block from birth,  first pacer at 19, am on number five.  10 years give or take or 15 years give or take for these leadless ones, you are going to be doing this for life.  thats not a bad thing, but they can put a traditional one with two leads now and like me 30 years from now three or four pacers later you might get a three lead.  and then have another handful or more pacers to finish out life.  far better idea to remove the old put in the new without cracking the chest or leaving big batteries behind in your heart or however this thing works.  

Let the doc use someone else as a lab rat for these devices, maybe consult another doctor, this is not making sense just yet would need to understand more. 

personal experience 1) if you have complete heart block you should get a pacer 2) traditional leads, traditional location, replace every 10 years give or take a few...

my two cents.

Your prior ablation procedure

by Triman67 - 2019-03-24 04:05:06

What does WPW stand for as the reason you had a prior ablation procedure?

traditional PM

by drew65 - 2019-03-28 12:10:16

dwelch, thanks for your input. How has your experience with traditional pacemakers been? Have you had any complications with leads or the pocket? Have you had to have any leads removed/extracted given the number of pacemakers you've had? That kind of seemed to be the EPs main argument for the leadless, that I'd have to have a number of procedures over the course of life to put in new leads with the risk of complications and potential removals far enough down the road. From your experience, though, it doesn't sound like you've had many issues. And I know from talking with a friend of my family who has had one (a traditional pacemaker) since age 12 (and is in his 50s now), he hasn't had any real issues either. I seem to go back and forth just about every other day on which of these might be the right option for me, but the traditional pacemaker certainly has a longer track record, and it is somewhat hard to argue with that. If you don't feel comfortable answering in a post, I'd be happy to send a private message. Or if you're not comfortable, I completely understand. Thanks again for your input.

WPW

by drew65 - 2019-03-28 12:28:59

Triman67, WPW stands for Wolf-Parkinson-White Syndrome. It occurs when there is an extra electrical pathway (an accessory pathway was what they referred to mine as) in the heart that can, at times, cause an excessively rapid heart beat. I first noticed this back in high school. I was on my school's cross country team, and during a Saturday long run all of the sudden my heart rate just took off on me. I was several miles out, so I had to walk/jog back to where I started and after resting a while, it eventually got lower. But after I saw a standard cardiologist and then an EP, the EP recommended catheter ablation to permanently correct the issue. Unfortunately, during the procedure to ablate the accessory pathway, the AV Node was damaged resulting in heart block. It's apparently rare for that to happen during the ablation process, but it happened. Usually, with 3rd degree heart block, they immediately put in a pacemaker, but I guess because of my age, they just didn't want to do that and wanted to hold off as long as possible. They did clear me to continue exercising, though, so I went back to running and competed the next two years. I continued to be fairly active for a few years after that, though in recent years I have not been as much. I still have been pretty much asymptomatic (no passing out or dizzy spells that I'm aware of), but they have documented some pretty low rates and pauses of up to five seconds on heart monitors when I sleep, which is why they've advocated the Micra (as a preventative measure to keep my from passing out during any unexpected significant pauses), and I do have a relatively low heart rate during the day (if my Apple Watch is to be believed, anywhere from low 40s – occasionally dipping just under 40 – to upper 50s when doing normal tasks up to around 120 or potentially a bit higher when exercising).

WPW clarified

by Triman67 - 2019-03-28 21:08:34

Wow never heard of that.   Hope my long pm to you the other day might have cleared up questions you mighrt have had about the Medtronics MIcra TPS.  That is the whole purtpose of mine to serve as a back up for my low resting heart rate with pauses up to 6 seconds at night also.  If you do get one make sure your dortor asks the  Medtronics sales rep for a dummy one you can carry around in your pocket in a little case  and show off to people and say this is a sample of the tiny little nano device inside me , amazing piece of technology!!   Good luck.

Thanks again

by drew65 - 2019-03-28 23:16:44

Yeah, it’s fairly uncommon I think. And I think it’s rare to have damage to the AV node during the catheter ablation too, but that’s just the way it worked out. Thanks for the tip on the dummy version and thanks too for the info you sent via private message. Just sent a reply on that a little earlier. Very helpful. Thanks again!