Now for the questions

The echo cardiogram came back essestially normal. Moderate tricuspid regurge but normal ejection fraction.

However, since I am clearly symptomatic to being paced in the ventricle Dr. D____ is ready to go forward with His bundle pacing. I mean ready. He wants to schedule Jan 30.

1. So now the questions. I"m familiar with HBP what is does, how it works etc., but I don't know much else. Like what is the power source? How long does power last? What might cause it to fail? What undesirable side effects?

2. If placing the HBP isn't ppssible, the NP's note says "a third wire will be added." 

Does this mean a third wire will be attaced to the current pacemaker? Or do I get a whole new pacemaker plus one new lead?

I do wonder if we continue to pace the rt ventricle, even with the left also paced, will the right ventricle still object? (it jsut doesn't like being paced.)

What are the pro and cons?

3. What else should I ask?

As always, thank you all for your help and support.

6 Comments

My thoughts

by Gemita - 2020-01-15 19:19:22

Dear Gotrhythm, 

So pleased you are moving forward.

The concerns/questions I would have are

(1) If you were to develop conduction problems from the HIS bundle lead through the bundle branches, affecting the signals to the ventricles AFTER the lead has been placed, how would this be overcome ?  

(2) Would it mean an immediate pacemaker upgrade and an additional lead into left ventricle and what about the HIS bundle lead, would this be redundant ?

(3) If the HIS bundle procedure is successfully carried out, what would happen to the redundant lead in the right ventricle?  Would it be removed or left to stay in place in case (1) should occur?

Cannot answer your technical questions but I would also want to know how many HIS bundle procedures your EP has carried out and his success rates? I would want to know the additional risks involved because of technical difficulties involved in placing the HIS bundle lead and of course the cost.

Pacing in both ventricles I believe will help eliminate most of your symptoms Gotrhythm whichever procedure you choose.  If your HIS Bundle procedure is in any way uncertain of succeeding I would feel confident about the third lead resynchronization therapy.  For me it sounds possibly more trouble free and long term (permanent) and well tried and tested, whereas HIS bundle is still in its infancy though the idea of HIS bundle is very very appealing if you are a suitable candidate 

Good luck for the 30th 

I would do it tomorrow

by marylandpm - 2020-01-15 20:54:35

   My EP would use the RV lead as a backup in case there is a problem with the HisBundle lead.  I am 100 % paced in the RV and believe my Afib and flutter are due to my RV pacing, however the hospital and insurance will not approve the HisBundle pacing as long as my EF is above 40%.   

AF and AFL due to LV pacing?

by AgentX86 - 2020-01-15 23:44:28

Mary... How does that work?  If you're only paced in the right ventricle, what does that have to do with what goes on in the atria? Why are you LV-only paced (I assume you mean VVI mode), instead of DDD mode (RA+RV)?

Yes, if you had no pacemaker, His pacing isn't a big issue but a change isn't considered necessary unless the EV crosses a minimum threshold (usually 35% but your insurance company is more liberal).

GotRhythm, I think Gemita has given you an excellent set of questions that should be answered before you go on.  Your EP should be able to give satisfactory answers very quickly.

So you're planning on abandoning the RV lead if the His pacing goes as expected?  Note that if His implant doesn't  go as expected, LV lead isn't a trivial implant either.  It doesn't screw into the muscle pretty much anywhere, like the RV lead.  It has to be snaked into a vein and across the heart to the left side. Catheters enter into the RA through the femoral vein and Vena cava and then have to get to the left side of the heart somehow.

RV lead

by marylandpm - 2020-01-16 07:16:11

  

I have a 2 lead pacemaker. Complete block, paced in both leads. I went into complete block in June 2015.I suspect I inherited the bradycardia since my mother had the same condition. I did a lot of mountain biking and tried to continue after getting the PM. I don't think I had Afib/ flutter before getting the PM.   I am very limited in my physical activies so I don't go into afib.  

The outcome--for me---for now

by Gotrhythm - 2020-01-16 16:16:17

I decided not go for either HBP or CRT at this time.

My current pacemaker will not support either, and a new pacemaker is required. I really don't want a new pacemaker. If I were a younger person, 35, 45, 55, even 65 my decision would be different.

The people I spoke to at Duke were very gracious and assured me the door was not closed and my decision could be revisited if my assessment of the cost/benefit ratio changed.

Thanks again to all who have listened to me and helped me think thihgs through.

Our technological world offers chances and choices undreampt of when I was young. Already we see that extention of life even when it's possible isn't always the absolute good it was once thought to be.

As time goes on, I think we will find ourselves both individually and as a culture neediing to make more and more choices, and perhaps finer discriminations around how much medical intervention we want.

A good decision

by Gemita - 2020-01-16 16:46:27

Dear Gotrhythm,

I expect a great weight has been lifted from your shoulder and your mind is now free to follow the path you always intended.   I support you wholeheartedly in your decision.  I am sure it has been a very difficult one for you to make but I believe it is the right one for you.

We know our own body best and sometimes the level of discomfort and uncertainty we are required to go through in order to reach our treatment goal is just not worth it.  To do nothing sometimes is also a perfectly sound option when it comes to our health.   Hubby and I are both having to face these major decisions too, so you are not alone.

I actually believe that now you have come to a decision not to fight yourself anymore you will find your heart will quieten and give you some peace.  I wish you well and you know we are always here for you

 

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