RIGHT VENTRICLE PACING

So much has been written (and has also been commented on in this forum)  about the potential problems associated with RV pacing which could lead to heart failure symptoms in some patients due to “dyssynchrony” between the two ventricles. 

My hubby 81 has a single lead PM to his right ventricle for bradycardia/syncope and pausing.  He also has AF and other arrhythmias.  His percentage of RV pacing is increasing rapidly after only a year (from 40 to 70%).  He has also had an increase in his AF episodes and his symptoms, particularly breathlessness, have become more apparent.  His heart rate is well controlled though and in fact he has never had really high heart rates.

We are due to have a follow up with his cardiologist (who is also an EP) in early February.  Because of my husband’s other health issues:  ischemic heart disease (3 stents), cerebrovascular disease (4 strokes), diabetes and a host of other problems, I don’t want to put him through unnecessary procedures (like an extra lead implant) which may be in his future we were told.  However, I am concerned that there has been a worsening of my husband's symptoms since pacemaker implant and his arrhythmias have certainly increased too.  I do wonder whether pacing with a single lead has adversely affected him in some way and whether I should be pushing for a PM upgrade ?  (Consultant suggested that some patients can develop adverse symptoms from RV pacing only).

Michael leaves all his health problems to me and doesn’t want to know what is really going on, which makes it difficult to know how to manage his symptoms at times.  His doctor is a good place to start I know, but any advice from my well respected members here, would be greatly appreciated.  Thank you


6 Comments

No,unless....

by AgentX86 - 2020-01-14 08:45:19

I'd say that any change is unwarranted as long as he's showing no symptoms of cardiomyopathy.  At his age, a prophylactic implant of a new device would be a case of the cure being worse than the disease (and you mentioned no signs of a "disease"). I also doubt that it would be covered by insurance (Medicare,  I assume).

 

pacing

by Tracey_E - 2020-01-14 09:58:30

The risks of not pacing and the heart being out of sync or rate being too low far outweigh any potential long term effects of right pacing. Some people may eventually develop heart failure but my ep said under 10%, and some of them would have developed it with or without pacing.

If he has heart block, it's common for that to progress so an increase would be expected. Many of us with heart block pace 100% and have for many years.

If his heart function were to drop substantially and if he was symptomatic, then it would be appropriate to discuss a third lead. An increase in pacing alone is unrelated to how the heart is responding to pacing. The pacer sends the message to beat, the heart responds by contracting. The pacer sending that signal more often doesn't automatically mean the heart is no longer responding (contracting) well. 

THANK YOU BOTH

by Gemita - 2020-01-14 11:21:49

AgentX86.  Thank you for your response.  Maybe I am over thinking all of this and I would be better leaving well alone.  It might certainly be safer, since Michael has a habit of throwing clots during heart procedures.  We are in UK so treatment would be covered under our NHS, especially if consultant recommends it in the future.  I believe he has some cardiomyopathy (dilated atrium).

Tracey_E.  Thank you so much too for your helpful response.  Just to confirm I am the Pacemaker Club member (with a dual chamber PM) and symptoms rather like my husband, although we differ in that I have AF with a rapid ventricular rate response and hubby has AF with a slow ventricular rate response.  (He only has a single lead PM).  Yes Michael has intermittent heart block (although not sure of degree/type).  I believe his main problem is caused by his arrhythmias and his AF has certainly increased in frequency and duration since PM implantation, hence my post.  His consultant mentioned his increased AF might be caused by pacing but I didn’t follow it up at the time.  But your final paragraph goes a long way to reassuring me that an increase in pacing percentage may not be significant in itself or need any intervention.

 

Pacing Induced Cardiomyopathy

by Terry - 2020-01-14 20:59:17

The body of data seems to favor natural ventricular activation by pacing the cardiac conduction system at the His bundle is healthier than adding a 3rd lead to pace the left ventrical called CRT. See the list of recent studies on the Papers page of <His-pacing.org>. I wish you and your dear husband the best.

Terry

UK and NHS

by AgentX86 - 2020-01-14 23:21:33

I'm sure the NHS has treatment guidelines for PMs and aren't going to spend thousands of pounds for no reason. or particularly when the procedure would be dangerous (throwing clots) and the payoff is nil.

Terry - His pacing

by Gemita - 2020-01-15 07:46:52

Thank you for your kind words.  Yes I have read a few papers about HIS bundle pacing and it does seem like a better (more natural) approach.  i will have a look at the website you posted since even if it is too late or not appropriate for either of us, it is always interesting to keep up with new research.  I suppose it would depend on the patient's condition being treated, since if they had problems with their bundle branches, am not sure that HIS bundle pacing would necessarily work well?

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