Questions About Upgrading from Pacemaker to CRT

CRT

by AgentX86 - 2020-02-18 15:54:36

The upgrade from a 2-lead pacemaker to a CRT would be on the order of his original PM implant. It's really the same surgery. Infection is always a worry but he came through it  before without complications. Worry? Sure, but don't get carried away with it. At least show him you're strong.

With a low LVEF, he'll likely get a CRT-D. Sure, the pocket will likely have to be enlarged somewhat but I don't see that as anything to be concerned with. Given his age and that it's a defibrillator, it'll probably be an overnight deal.

Thanks for the reply

by BarbD - 2020-02-18 16:21:47

Would they put a defibrillator in a very frail 87 year old man?  I can't even imagine what would happen if he received an inappropriate shock.

BarbD

by Gemita - 2020-02-18 18:12:41

I can understand your concern. My husband is 81 and may well need a pacemaker upgrade too and has suffered several strokes in the past.  He also has coronary artery disease and stents.

My feeling is if doctors are prepared (at least here in the U.K.) to undertake upgrade pacemaker surgery on a frail person, there has to be good reason and a likely positive benefit otherwise they just wouldn't do it.

As far as Entresto is concerned I would ask for the lowest possible dose to help with your Dad's heart function without causing him undue side effects.  I agree totally that dizziness in the elderly is not benign nor is worsening kidney function but you may find he tolerates low dose Entresto well.  If not ask for an alternative med or combination of meds to help him. I am just the same with hubby.  He is doing well on lower doses of all his meds whereas on full doses he was getting less stable and weaker.  It is all about finding the right balance and treating the whole person not just the condition.

Good luck to you both

three lead

by dwelch - 2020-02-18 19:55:27

We chatted in another message.

AgentX86 pretty much covered it 

I had 2 lead pacers for around 30 years, we removed device number 4 before it ran out of juice to put in a three lead for device number five.  the 4th one was very tiny compared to any of my prior devices, they had kept getting smaller since the 1980s.  the new one is larger but not huge, an ICD will be bigger they may have one you can touch/feel or maybe you dont want to and just deal with it when it is in.  If he needs it he needs it.

As pointed out above it is not much different than the first implant other than he/you have been through this before so for the most part it is not new, it is not exactly just a device replacement as the new lead is there, but it is closer to a device replacement than the first time.  Overall it should be easier than the first time because he is experienced now.

One thing I didnt mention in my other message is having a lead on this other side has the chance of stimulating your tummy muscles, belly bumps or whatever your/his nurse may call them.  I sometimes get them I have to stand just right and breath in just right and it will happen.  Too much of a signal and this may happen more often, too little and it wont make the heart muscle fire as they desire, so there is a sweet spot in there and it may take an adjustment or two on the new lead to get that setting just right, or he may never experience this belly bump thing at all.  I found it more amusing than annoying, if I could make it happen on demand it would make for a fun party trick.  If it were happening 24/7 then I would simply call them and come in asap to have it adjusted.  I would have no worries about it.  Never hesitate to call them.  I only point this out as a remote possibility that is not something to fear of it happens.

shorter answer.

The prodedure is not really much different than his first one.  The overall recovery is different only in that he has experienced it already and knows what to expect.  also he is already being paced so things like learning to sleep again, etc he shouldnt have to go through he is already used to the pacer and they will use the same settings.  This ideally will help the EF and make things even better than before, will see how he responds to it.  The recovery should be same/simpler than his first device.

"if he received an inappropriate shock"

by AgentX86 - 2020-02-18 22:27:36

The chances of getting an innapropriate Jesus Jolt, As RoboPop likes to say, is miniscule compared to the chances of him getting one that will save his life.  No, it probably won't make his day but it might make the next one possible.

Talk with his EP and express your concerns.  I'm sure they've thought through the alternatives and can explain exactly why they're doing what they're doing.  If they can't or don't want to take the time, find an EP who will.

Re: inappropriate shock

by N8UAD - 2020-02-19 21:33:29

Perhaps you don't understand the gravity of the situation, if his "EF" has fallen to the level you say it has he is now more apt to develop an arrythmia, that an ICD can easily correct with a "Jesus Jolt". The is little risk (read very very tiny) that he will receive an "inappropriate shock". I have an ICD, a few years ago I took a nasty fall that damaged one of my leads to the point where an "inappropriate shock" was VERY possible. While I waited a couple months to get the lead replaced thay gave me a special maganet that I was to put on my device if it started delivering "inappropriate shocks". The chances of an "inappropriate shock" being fatal are slim but painful. In other words the benefits far outweigh the risks.