2 months in new CRT - D

Hi all, 

52 year old male with 2 month old Boston Scientific CRT 247.  Still out of breath upon minimal exertion.  Prior to implant, this was not the case.  I lead a very normal life even though my EF was 20%.  I was treated for bradychardia and arrythmia's.  Sometimes getting out of the car and walking up a set of steps can have me feeling sluggish....other times not.  No rhyme or reason to activities that take me from 60 bpm to 85-90 and feeling like my legs are heavy...I was pretty active before.  The thought of climbing steps has me thinking twice.  Never the case.  

My EP tells me that I have to be patient and wait.  For some reason I am feeling like I need a second opinion.  I am out of breath at 100 bpm briskly walking on the treadmill.  I have to stop when walking up mild inclines - this was never the case.  Feeling frustrated.  I don't feel like waiting 2 more months.  Something is off.  I know my body well.  Am I crazy.  Does it really take that long to my heart to get accustomed to pacing?  I am fearful that by exercising I am doing more harm than good.  Help


Ask to go back for additional checks and a full review

by Gemita - 2020-11-19 04:48:16

Hello LD1708,

You are not crazy and of course you know your body best.  We all do.  I wonder if your arrhythmias are again causing the problem ?  I see you were treated for these in the past.  I have good heart function but oh dear when I slide into an arrhythmia my heart is all over the place and so is my pacing.  I too can struggle for air as I climb stairs and I can also experience mid central chest pain.  

Unfortunately the pacemaker will not help stop an arrhythmia or fast heart rate, although your defibrillator will certainly stop a dangerous arrhythmia/fast heart rate if it sees one.

Have you had any recent external monitoring to try to pick up what is happening?  It is certainly true that some of us need a few months for the pacemaker and heart to settle.  Your situation is more complex with your low ejection fraction which may take more time to improve with CRT and any medication changes.  In view of your worsening symptoms though I believe you should be seen as soon as possible for a few checks, maybe even a medication review?  I remember my medication needed changing soon after pacemaker implant.  Pacing can certainly affect our medication requirements and medication can also affect our pacing requirements, so maybe some adjustments to both medication and/or pacing might be required?

In an earlier thread, you mention urine output has declined.  I hope you will have a full review with your doctors and maybe some bloods taken to check kidney function, look for anaemia, infection and other conditions which might be causing your symptoms.  With heart failure symptoms, please do not try to be brave and push through them.  Ease off until you can be seen.  Hopefully it is something that can be helped.  Good luck and stay safe

Who to ask

by Gotrhythm - 2020-11-19 16:18:15

I'm not as familiar with CRTs as with pacemakers, but if we were talking pacemaker, I'd say your settings might need to be adjusted--especially rate response which might not be speeding up quick enough.

But that's just me. What you really need is to talk to someone who is knowledgeable CRTs and your case in particular. That person should be your doctor but apparently isn't. I've learned that if I'm not happy with a doctor's answers, that's reason enough to try someone else.

You don't have to fire your doctor to get a second opinion. I've never been sorry I sought another doctor's help, but I have regretted waiting.

If you're wondering if you should seek a second opinion, I think the answer is, you should. The worst that could happen is that the second doctor will tell you exactly the same thing as the first.


Recent CRT-D

by Aberdeen - 2020-11-19 17:20:31

Hello, Gemita and Gotrhythm have given you excellent answers to your post.I only wanted to add that I have had a CRT-p for 6 months. From day one I felt better regarding my SOB due to Bradycardia. I too have a low EF.

Good luck and I hope you get answers and feel better soon.


by AgentX86 - 2020-11-20 19:27:01

A CRT shouldn't be any different in this way than a non-CRT PM.  If you're not up to what you were before, it's time to get some help.  You may not see an improvement right away but you shouldn't be going backwards either.

Do you, by chance, also have SI node problems, specifically chronotropic incompetence?  If your pulse is limited to 100bpm, rate response my need some major adjustment.  If not, perhaps there is something really wrong with your maximum rate?

You're unlikely to hurt yourself being limited to 100bpm, so I wouldn't stop exercising.  I'd certainly be knocking on my device clinic's door asking a lot of "whys".

I do a lot of walking and my rate never gets over 110bpm but it works for me.  I'm never SOB, barely puffing at the top of the largest hills in the neighborhood.  They aren't that big but my rate rasponse doesn't sense stairs. Two flights gets problematic so I don't consider it that bad.

You know you're wired when...

You run like the bionic man.

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