Last Question for the day (I promise)

Remodeling

by AgentX86 - 2019-12-29 23:42:33

Remodeling is caused by unequal pressure in the RV and LV.  My cardiologist explained it using the thought experiment of a water baloon.  Squeeze one side and the other bulges out.  With RV only pacing, the RV is paced a few tens of milliseconds before the LV.  In that time, the pressure in the RV builds up, so the LV is somewhat stressed.  If both sides contract together the pressure is more equal and one ventricle supports the other (both halves of the water baloon squeezed at the same time). In a small minority of cases, this causes the LV to enlarge, or "remodel" (LV  cardiomyopathy) and a drop in LVEF. 

If His or CRT pacing is used, the heart's natural timing is used (His) or an artificial timing, using the PM is used to synchronize both ventricles to "squeeze" together. The timing of a CRT can be changed to precisely time the RV and LV to optomize the LVEF. 

If reodeling does occur, CRT pacing can be used and the remodeling is usually reversable before any permanent damage is done. 

Because the potential problem is caused by a dyshronization between the LV and RV, it has nothing to do with RA pacing, rather RV pacing.  Since you say you're 90% paced in the LV, it may be an issue but the chances are very low.

Relax and enjoy life!  Your EP/cardiologist will be watching for this.  You can, also, if you wish but it's not something to worry about at this point.

Thank you

by Johnny63 - 2019-12-30 00:00:04

I appreciate your time and explaination. The last thing I expected a few weeks ago was the situation I am in now. The subject matter is new and seems quite complex. I am also concerned about having the proper settings for exercise and then cooling down. I have a lot to learn. I appreciate how helpful and informative people on this site are. Best wishes and thanks again. 

To Sum Up ??

by Gemita - 2019-12-30 03:09:10

Hi Johnny, well have you digested all the info you have received on Day 1 ??  This is certainly a crash course for you. I guess when we ask so much all at once it can be overwhelming but at least it gets the job done and you can then sieve through all the info and see your doctor for the final assessment of where you are.

So we have established your pacemaker model and make, how much you are being paced in upper/lower chambers, that you indeed seem to have a dual chamber PM.  Now I would want to know

- where exactly the leads have been placed (this info should be on your hospital discharge notes), particularly whether the right ventricular lead has been placed in the HIS bundle ??  Explain you are primarily concerned about the potential to develop heart failure in the future from heavy right ventricular pacing leading to ventricular dysynchrony.  Explain you need to be reassured that this risk has been MINIMISED through perhaps the choice of PM implanted and the POSITION of the leads ??

- whether you are free from Sarcoidosis and any significant coronary artery disease since I note you are due for re-testing ??

- whether your PM settings are optimised for your required level of activity ?

This is just the start of your journey of living with your PM.  There is a long long way to go so don't do too much all at once otherwise you will wear yourself out. The PM will do the work for you!!  Trust your doctor and if you cannot, find one that you can trust.  It can make all the difference. 

heart block

by dwelch - 2019-12-30 04:01:15

you have heart block, so you said and as one of your docs pointed out:

"your situation is very simple. The upper chamber is healthy, your lower chamber is healthy they are just not communicating."

And that is all true it is very simple.  All the pacemaker has to do for you is listen to the upper chamber and fire the lower in sync.  Dont need anything more than that and you can run and swim and whatever you want to do.  They tend to put an upper and lower limit on us for some reason, but at the end of the day for heart block all the pacer has to do is synchronize the upper and lower chambers.  done.  period.

You dont need a third lead (not for 20 years if ever).

You have the few week visit the few month visit, maybe a 6 month visit then annual visits after that until the next device.  If you have the take home monitor box, if you dont have the take home box then they may bring you in more often over the life of the device.

Focus on recovering from the surgery, dont push it.  Get back to doing the things you used to do, which should come easier now, heart doesnt have to work as hard.  "Enjoy" these first checkups as the tech messes with your heart during the few tests.  Ask for your copy of the report/printout ask the doc what the settings mean or some of these questions, remember they are limited and have to be careful what they say for fear of lawyers so will err on the side of caution (unlike the folks here on this site we can tell it like it is).

If you can get past this issue, then during the test they turn off the device and capture an ekg without the device interfering and they also capture the ekg with the device doing its job, it is VERY easy to see the device working between those two plots, even if it is a half a dozen beats you can see heart block and you can see what the pacer does to fix heart block.  It does this every heart beat every day.  And it is doing it with two leads, even if poorly placed.

Thank you both

by Johnny63 - 2019-12-30 15:48:28

Thank you both for your detailed and thoughtful messages. The input and advice really helps as I get a handle on all this.