Maintaining my heart muscles Ejection Fraction and Condition

  Hi, this is my 3rd post to this forum. I am very pleased that this site even exists and I have a lot of questions. I presently know enough about my PM to be dangerous, lol.

  From my earlier posts you will see that I received what I think (not certain) is a Dual Chamber PM roughly 3 weeks ago. It is a Saint Jude PM.

  With the holidays and all the confusion, I haven't had much time to analyze my situation. I know I feel a lot better than I did before in many ways and I thought I felt good before. So I am very thankful. Being in that cardiac unit for 3 days, 3 weeks ago came out of the blue and was quite sobering.

  Exercise, particularly swimming, is very important to me. Over the last 5-6 years, I transitioned from running 5-8 miles a day to swimming 1-2 miles a day 4 to 5 days a week. I am not a Masters Swimmer, I just enjoy swimming as a way to stay in shape and maintain a positive attitude.

  My question is this, my Ejection Fraction at the time my PM was implanted 3 weeks ago was 65%. I had never heard of an Ejection Fraction before and I was told this was good. After a little reading I have learned that some people experience a deterioration in their Ejection Fraction after the implantation of a Dual Chamber PM. Does anyone know how likely that possibility maybe vs the possibility of my maintaining my current Ejection Fraction, or improving it? 

  Also, if I continue to exercise, can that preserve my Ejection Fraction going forward, or might exercise cause it to decline given my Dual Chamber PM's involvement. Should I explore the possibility of a Bi Ventricular PM? 

  I would greatly appreciate any input other athletes might have regarding the questions I asked, or pertaining to questions I didn't ask but should have. Thank you. 




One day at a time

by Gotrhythm - 2019-12-29 16:35:41

In any journey, the thing that matters most is to start where you are. That's obvious, right? But a lot of times we try to start by solving every problem that might arise in the next ten years. That doesn't work.

You have all kinds of questions about what happens (that's bad) if you have a dual pacemaker, but you don't even know for sure that you have one.

So starting where you are means finding out what kind, make and model pacemaker you have. Based on my experience that's a question you could find yourself needing the answer to within the next several months.

Since athletic performance is important to you, you would do well to learn what your pacemaker settings are, and what those settings mean. From what I've observed the right settings make a lot more difference in younger, more active people. In the next several months you may need to work with your EP to obtain the settings that are optimal for you.

About ejection fraction: there is no payoff in focusing on that. In the first place it's not a real amount of anything. It's a guess, an estimate, an inference based on other measures. As long as it's in the normal range, it really doesn't say much about how well you are.

Finally, about heart remodeling--that's the problem implied by changes in ejection fraction. That happens sometmes, but it isn't inevitable. There's about a 10% chance. Which means there's a 90% chance you'll have no problem. You would not be able to find any doctor today who would be willing to do anything about it because you don't have it now and there is no way of knowing if you will ever have it.

This is your first pacemaker, but with any luck, it's not your last. Who knows in ten years or so when this one needs replacement what technology will be available? Make the decision about what new device you need then.

About analyising the situation. The truth of the matter is, for the otherwise healthy, a pacemaker only takes a condition that would have sidelined you sooner or later, and makes you able to stay in the game.

Ideally, a pacemaker doesn't change your life much at all. You were okay before. You're okay now.





Thank you

by Johnny63 - 2019-12-29 16:47:58

You're advice was very logical and wise. I appreciated it. I didn't know the percentages you shared regarding the likelyhood of heart remodeling. Those numbers were quite reassuring. Dealing will a problem after I have one makes a lot more sense than trying to anticipate and prevent problems before they occur. Thanks for reminding me of that. 👍

I know how you are feeling.

by Graham M - 2019-12-29 18:12:31

Hi Johnny,

It's quite a shock when you think that everything is OK and all of a sudden you're in the hospital having electrodes attached to you.  I collapsed whilst loading shopping into my car, and was taken to hospital, given an ECG, an echocardiogram, several x-rays and had a PM implanted all within 24 hours.

To cut a long story short, I have Type 2 AV block and my echo showed an ejection fraction of >70%.  A subsequent CT scan showed only minor calcifications and little chance of coronary heart disease, which is surprising since I smoked from the age of 15 until August this year.

I haven't done anything sporty since I was in my early 20's, but have always done a lot of walking and tried to keep as fit as possible.

After a few weeks recovring from the surgery, I began to feel more energetic than I had for at least 18 months, and it continues to get better.

To answer a couple of your questions:-

The pacemaker will not make your heart any stronger or weaker, all it does is stimulate it to beat at the right time.

When your left ventricle contracts, it does not push out all the blood in it, just a fraction.  This is called the ejection fraction and is estimated from your echocardiogram.  Normal EF is between 40 and 70%, so if you fall into this range, you should be OK.

May I suggest that, as well as talking to your Dr. and Pacemaker Club, you hit the internet and find out as much as you can about heart block and pacemeakers etc.  There is a lot of really useful information, and I have found it invaluable.

Best wishes,



by Johnny63 - 2019-12-29 19:28:37

Thanks Graham, that's good advice. 

Good catch

by PacedNRunning - 2019-12-31 19:50:35

Your spot on about worrying about low EF caused by pacemaker remodeling. The key is to not unnecessarily pace. So you should only pace what you need and not more. I have intermittent block so I should only pace on demand and what I need. We worked on getting that down this first year bc I was unnecessarily pacing and we knew it. But studies show greater than 40% RV pacing can lead to low EF. But like someone else said. It's a low risk but can happen as soon as 18 mos is pacing greater than 40%. Not sure why you have pacemaker or how much you pace but I've seen people paced 100% and do fine for years. The key is there is a fix by adding a lead and make sure you pace what you need. My EF before my pacer was 62%. I just had one 16 mos post implant and it went up to 68%. Probably because I had one heck of year getting the right settings and my heart went through some rough pacing. It made it stronger. 😂 I was high as 60% to now down to 36% last check!  

I wouldn't Worry too much. Normal EF Is 50-70 and or doesn't reflect fitness. 

Good imput

by Johnny63 - 2019-12-31 20:11:15

  Hi, thanks for the imput. I have 2nd/3rd degree AV block with a Dual Chamber PM. I was told my pacing is only 7% in the upper chamber; yet over 90% in the lower chamber the day I was released.

  My BPM the day I went to the hospital was 44 roughly. I was walking and functioning pretty well when I arrived at the hospital because my normal resting pulse was in the mid 50's; yet later my pulse got as low as 40 and I became light headed and short of breath then.

  How could I safely reduce the pacing, I wonder? 



by PacedNRunning - 2020-01-23 04:38:49

You can only reduce pacing if it's intermittent block. If your in persistent block it's hard to limit. Limiting is easy if you don't have  AV block. You have AV block so it's not wise to try and reduce it. With mine, it's rate related and I block once I'm over 120 bpm at surgery to now down to 70-80's. So we can make adjustments to make my pacing start at a certain heart rate but mine is unique and I highly doubt yours is rate related. So your probably where you need to be. :) 

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