Heart function

Hey All,
So I am a63 year old female and got my dual chamber pacemaker in 2014 when I was 57. The past 19 months have been insanely stressful as my younger sister had a brain aneurysm burst,  followed by a massive stroke. During that time I was making the 2-1/2 hour trip plus a 1/2-hour ferry ride (each way) running back and forth between where I live northwest of Seattle and the hospital 1 to 2 times a week. Long story but she was stuck in the hospital for 11 months. :(
Fast forward to yesterday when I went to my cardiologist and had an echo and an EKG done. My heart function is now down to 47% from 58% last year so he is sending me to see a cardiac electrophysiologist on the 28th to see if I'm a candidate for a biventricular pacemaker. The stress of the last 19 months plus a fairly significant weight gain and lack of exercise have all contributed in lowering my heart function. 
My question is... Have any of you had to go from a dual chamber to biventricular pacemaker? Talk about stress. I'm really anxious about the procedure and then I just read that the prognosis for people with heart failure is bleak, with about 50% having an average life expectancy of less than five years. That was dated 2008 so I'm hoping that's not accurate. I've also read that Pacemakers implanted for slow heart rhythm restore life expectancy to normal levels but that was dated 2013. Anyway, I would really appreciate any input or insight you might have. Thank you.
Damie Rodriguez


Ejection Fraction

by Gemita - 2020-10-15 08:31:19

Hello Damie,

I hope your sister is making progress and will be able to recover some strength and mobility.  

I understand how worried you are about your fall in Ejection Fraction (EF), but my feeling is that until you have seen your Electrophysiologist for an opinion, you may be worrying unnecessarily and prematurely.

My understanding is that normal EF is somewhere within the range of 50-70%, below normal EF within the range 36-49% and low EF 35% or less.  Other tests as well as assessment of Ejection Fraction are usually carried out before a diagnosis of heart failure can be confirmed.  It may be that with improved treatment you can easily get back to within a normal range of ejection fraction.  Improved treatment could be anything from an upgrade of your pacemaker as suggested by your cardiologist, to medication changes and better control of other health conditions like high blood pressure, diabetes, thyroid disease, anaemia, infection or an arrhythmia like Atrial Fibrillation.  Increasing physical activity, a healthy diet and reducing your stress levels will all help too to improve your heart condition.

I believe you will be able to restore a normal EF if you take control. An upgrade to a biventricular pacemaker may be in your future to help restore synchrony between the left and right ventricle if this is needed and you are a suitable candidate, but you may find your Electrophysiologist might want to try other less invasive treatments first,  But please do not start imagining that you are in the last stages of heart failure because you are clearly not with a 47% EF (which is only slightly down from normal range).  Hopefully your Electrophysiologist will be able to give you lots of reassurance and support to prevent any further decline.

Good luck for the 28th

Heart- dual function to CRT pacemaker

by Aberdeen - 2020-10-15 09:35:57

Damie,                                                  Sorry to hear you have had such a stressful time lately. I had a dual chamber pacemaker implanted in January 2020. All was well until I  collapsed in May . The pacemaker had caused the left side of my heart to become out of synchronisation with the right side. I don’t think this has happened to you as this was only 4 months later.                                                      

I was fitted with a CRT pacemaker in May.If you need this the box is replaced and the original two leads remain in place and a third is added. I didn’t have any problems healing and now I seemed to have become accustomed to my medication I feel well. Coincidentally I am going for an echocardiogram today and I am hoping my EF has improved.

Try not to worry if you need a biventricular pm or CRT pacemaker the success rate is quite good.

Good luck!

dropping EF

by Tracey_E - 2020-10-15 10:41:14

You are just barely out of the normal range so I can't imagine you're ready for a CRT just yet. The thought of dropping EF and heart failure is scary, but between new meds and CRT, the prognosis is better than ever. The data you found is old. It's time to pay attention, but I don't believe it's time to worry. If I had to guess, I would say they might consider CRT when you have your next replacement. Your EF is not bad enough to warrant a change now if you still have battery life left and are not symptomatic. 

You might want to ask your doctor about a nutritionist and cardiac rehab to get some help getting out of the weight/out of shape spiral, maybe talk to someone to get some tools to deal with stress. We can't control everything, but we can take control of these areas and fight back. 


by AgentX86 - 2020-10-15 21:29:51

Wow!  You've had some time!  I hope your sister is doing better.

As others have said, you're just out of the LVEF normal range.  I think you're reading too much into this, though your weight gain may be worrying (fluid gain).  Have you actually been diagosed with heart failure?  Even if so, it may be temporary.  When I was first diagnosed with AF I was in heart failure.  That was 14 years ago and no sign of it since.  I've been through a lot of things (including a CABG, three ablations, and an AV ablation) and still no signs of HF.

If they're looking at a CRT, you are probably showing some cardiomyopathy.  I doubt that you'll ger a CRT pacemaker, at least yet.  Unless your EP has a really strong case, insurance companies want to see the LVEF below 35%, or even 30%.  They'll use a CRT-D at that point but you probably aren't there yet.

I have had a CRT pacemaker from day one, not because of a low LVED (55-60%), rather my AV ablation.  Since I have no atrial function, they don't want to take any chances with my LVEF.  Changing to a CRT isn't a big deal though.  It's no more complicated than the original pacemaker.  It's really the same thing (new generator and lead).  It does take a good EP to thread the third wire into place.  It's not a trivial procedure but not any more difficult for the patient.

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