EF getting lower

I had a pacemaker/defibrilator installed in March 2015...My EF at the time was 25%...all the women in my family  have an electrical problem with the heart...I was having 30,000 PVC's a day.....i have 4 leads....I was put on Entresto, Flecainide and Metoprolol Tartrate....the first echo after the implant my EF was 55% which was great since that's the same EF I had when I was first put on BP meds....here it is 5 yrs later and the EF is now 41%....I'm a bit worried about this...I feel fine, but still it worries me...I'm hoping the next step is not a heart transplant, but not sure what else can be done....

Question: My first cardiologist in NC tested my pacemaker in his office every 3 mos...I knew how long the battery was going to last and how active I was.....now, I have a diff cardio in NJ and  he only tests me with my Merlin machine ....No one ever gives me the results, and it's done every 3 mos....I would like to know if anyone gets their St Jude ICD measured in the office, or do you rely on the Merlin?...thank you all.


EF Lower and Merlin

by AgentX86 - 2020-05-28 21:46:23

If your pacemaker was implanted five years ago, there is little chance it'll need replacement in the next couple of years.  Even if so, the uploads from your Merlin box will identify the problem so that it can be replaced when needed.  You're being told it's OK.  The estimates, at this point, will be next to useless.  It'll basically say "everything is fine" or "do it soon".  Anything between is just a guess.  You also should be able to get all of the information from the interrogation.  This will show the estimated battery life but, again, it's only a guess. You still should have in-person visits at least once a year to make and needed adjustments to your PM. 

It's great that your CRT pacemaker increased your LVEF dramatically, though it has to be dissappointing that it's since been decreasing.  It's still not all that bad, though I understand your worry.  It would be a good idea to talk to your EP about this and see if there are setting changes to tweak the RV/LV synchronization to improve this.  Of course, interrogations, whether remote or in-person, won't say anything about your LVEF.

Also, I don't understand your comment about "4 leads".  I've not heard of such a pacemaker (three is "standard" for those with HF)  but would like more information if you have a pointer.



EF lower and Merlin

by Global408 - 2020-05-28 23:13:40

Thank you so much for your comment...I just had a video chat w/my cardio and he said the EF is 40-45%, but he's okay with that and everything else seems to be okay....I thought I had four leads to the pacemaker but maybe it's just three...I must start a regular exercise regimen, and that's my fault.....


by AgentX86 - 2020-05-29 21:05:07

Exercise is very important.  After my CABG, my cardiologist wanted me to walk an hour a day.  There was no way I could come close to that at the time.  He started me out with cardiac rehab, which gave me the confidence to take it further.  Slowly, I started walking more an more, often during the day.  I'd take five or ten minute breaks at work and walk.  By the time I had my PM implanted I could do 10-15 miles a day. That really made a difference.  I' was doing ~20 but (since the gyms are closed and I've been furloughed, I just do 10mi before breakfast and work around the house the rest of the day.  Being in shape really makes having heart issues a lot easier.  I also lost a lot of weight, making the difference all that much more. 

I'm not suggesting that anyone take it to the extreme that I have, just do what you can and challenge yourself to do more, without hurting yourself.  The benefits aren't limited to the heart. Walking is the perfect exercise and you can take the equipment with you anywhere.  ;-)

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I have an ICD which is both a pacer/defib. I have no problems with mine and it has saved my life.