Increased level of junctional beats after upgrade to 3rd lead added to Left Bundle Branch
I recently (12/9/20) was due for a replacement pacer and was "upgraded" from a Medtronic 2 lead Revo unit to a Medtronic 3 lead Serena unit.
The main reason I went for the 3 lead unit was the increase in pacing in the ventricles with the 2 lead Revo unit. I decided to get what I hope are the benefits of synchronized vent pacing over time instead of fighting cardiomyopathy later on- my choice.
Regardless, a bigger issue I had prior to this upgrade was junctional rhythm, competing with the pacer. I could never tolerate a rate over 60 bpm, and my junctinoals hover right around 60 bpm or so. So, basically I have lived with the bouts of pain that the junctionals bring me when under stress, etc, as a trade off.
With the new 3rd lead added, I am at a rate of 60bpm. During interrogation of the pacer, at 60 I over run most junctionals, maybe 70%. But, put me under stress, and I go back into full junctionals.
I had the EP turn the pacer up while there for the interrogation up to 70 bpm, and sure enough, I my heart rate was outrunning the junctionals, probably 95% of the time. But, just sitting there in the EP office for 10 minutes at 70 bpm, I just feel a heavyness in my chest that I dont feel beating at 50/60bpm. So, I choose a route to take for a test- leave the pacer at 60bpm and now am trying a common Beta Blocker which there is plenty of info here on our site, Metoroprolol.
I just started the beta blocker today, so I cannot at all report any result. The hope is that any junctionals that get through at 60bpm will be taken care of by the beta blocker.
If that does not work, then I am going to give 70bpm a try for a few days, just as a last try before I seriously consider a much not wanted ablation.
The point of all this data is that my experience since receiving this 3rd Left Bundle Branch lead is that my junctionals are alot more consistent and symptomatic(meaning chest pain) than when I had the two lead pacer).
The EP of course, as good as he is, does not have a pacer in his body and does not understand other than technically this should not happen. But, it is, it is what I am experiencing.
This is probably a niche question, one would need to be upgraded from a 2 lead to 3rd lead pacer, but I will throw it out there:
Anyone notice an increase in the duration and symptoms of junctional rhythm after a 3rd lead was added to your heart?