Raising Ejection Fraction with pacemaker

In August of 2018 I had heart surgery to replace my porcine aortic valve (2011)with mechanical valve, mitral valve repair, and triple bypass. My Ejection fraction prior to surgery was 40-45%. I have had 3 echocardiograms since then, last one in May 2019. My ejection fraction has been at 20-25%, Entresto in March raised it to 30%.      I really don't have symptoms of that lowered EF, I work 50-60 hours a week, cut firewood, work out on rowing machine 6 days a week. 

My cardiologist in June talked to me about this. He says the surgery can sometimes cause the EF to lower like that, but is very confused as to why I don't have the symptoms that I should.         He is wanting me to have a pacemaker put in to raise the EF. I told him I wasn't ready for that yet, will talk to him in December about it. I do have a good relationship with him and trust his judgement.

I have 2 questions about this. 1)  Can the echocardiogram be wrong? The same tech has done the last 3 echo's, am curious whether I should go somewhere else for my next echo to see if results are the same?      2)Does a pacemaker generally improve the EF?

 


9 Comments

EF is just a number

by Benjijohn - 2019-07-30 09:24:28

I can clearly understand your concerns. My initial as well as my current situation is far worse than yours. My EF is much lower but I still feel the same way you do

I had very long conversations with many doctors. They all assured me that as long as I feel fine and the situation does not get worse, I should not be bothered too much with my EF. 

Surely the doctors are also giving  a bit positive reinforcement and psychology, but as long as I can somewhat do what I want and the quality of my life is not totally reversed, I stopped thinking about my EF

I know the additional risks with regards to low EF  such as arithmias etc, but we should trust our doctors and live the life we deserve without worrying too much about things that are beyond our control

wish you the best

Paemakers

by Terry - 2019-07-30 11:04:52

Pacemakers are used to restore ventricular or atrial activation, most recently by activating the cardiac conduction system. (Google that or see <www.His-pacing.org>. Can you look at your "e-chart"? See if it refers to heart block, or especially left bundle branch block. The most recent and most physiologic way to correct that can be found on the website I mentioned and on the "Papers Page." Scroll down the categories to find the appropriate category of those scientific papers. Mitral valve replacement can, rarely, disrupt the left bundle branch of the cardiac conduction system.

All the best,

Terry 

EF measurement and how you feel

by crustyg - 2019-07-30 12:59:19

There's a certain amount of subjectivity when the echo tech measures your EF.  The tech can slightly alter the measured area before and after ventricular contraction, so a couple of percentage points either way is within the limits of the measuring technology

Although EF is a useful measurement, it's still just a number and if you feel good then your heart is producing enough blood supply for your brain/muscles to do what you want.

Heart output is controlled by two things: amount of blood ejected per beat (LV EF) and number of beats per minute.  HeartRate*beat output==heart output.  Your nervous system and some drugs can increase the intensity of each beat, if your heart muscle can achieve this.  For patients whose heart beating pattern is abnormal (should be atria=>then ventricles) a PM can improve your EF and your heart output - this is cardiac resynchronisation therapy and it's been shown to work for patients in heart failure.

Otherwise, pacing you seems *unlikely* to increase your EF - but it will increase your HR - and this isn't *necessarily* a good thing.  So the short answer to your Q2 is 'No, not usually' - except where it restores contraction sequence.  Sounds as though you have a good relationship with your heart doc: time to express some of these doubts to your doc directly!  And keep emphasising that you feel well and can do everything that you want to, as you are at present.  Everyone here either *had* to have a PM or other implanted device, OR couldn't do what they wanted to without one.  Me included.

EF

by ROBO Pop - 2019-07-30 13:26:47

If it ain't broke, don't fix it.

If pacemakers fixed ejection fraction as well as some doctors claim you'd have a whole lot less deaths in the world and far more happy people here.

Yes in some cases pacing can help improve cardiac output, but frankly that not often the case. All indicators are it should have helped me but my EF is still lower than a politicians IQ.

If you aren't experiencing symptoms say NO!

Statistics and Low BP

by bosshog - 2019-07-30 17:45:22

Thanks to all  for the info!  Several of the things my cardiologist told me were that with low EF statistically I am at more risk of heart attack. He also said that 1 in 4 patients prescribed a pacemaker actually need it, which is better than numbers in the past. Previously was 1 in 12 prescribed.  

I do have very low blood pressure , partly from carvedilol and Entresto. BP runs normally around 100/68. Can a pacemaker assist in raising that a little? 

Lies, Damn Lies, and Statistics

by AgentX86 - 2019-07-30 23:08:31

I'd like to know where your "cardiologist" gets his "statistics".

No, a pacemaker is very unlikely to change your blood pressure much at all, either way,

vote

by ROBO Pop - 2019-08-01 07:08:46

Let me recast my vote. I got so hung up on "raising EF with a pacemaker" that I overlooked what's really important here.

Your Doctor should be, and probably is, talking about implanting a defibrillator (ICD or CRT-D) both of which do indeed have built in pacemakers but serve an important function...reviving you from an SCA

When the EF is at or below 30% you are at increased risk of sudden cardiac arrest and very few survive an SCA without a defibrillator.

So while I'm still doubtful the device will improve your EF, it will improve your survivability. You should seriously consider getting one, those of us who've been through it will attest it beats the alternative.

Re: Vote

by bosshog - 2019-08-01 20:08:47

That is exactly why my doc is recommending a 3 lead pacemaker. The risk of heart attack is why he is becoming concerned. I am going to go ahead with his recommendation in December when I go back to see him. Thanks

blood pressure

by Resistance is futile - 2019-08-11 13:10:12

Just a note - the main purpose of Entresto is to lower your blood pressure so there is less stress on your heart. BP of 100/68 is good. When it drops and stays under 90/60 and you are lightheaded/dizzy, then it's time for action..

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