Question on upcoming procedure

Hello again!

Two days ago I had my pacemaker switched to MVP mode. It may have helped, I feel tentatively better, nothing dramatic, perhaps too soon to tell. My EP went ahead and scheduled the following procedure- 

upgrade PM SING, DUAL, OR CRTP TO CRTD; 33233+33249

can anyone enlighten me as to what that means? I know it is basically inserting a possible third lead.

Also, in my darker moments I think perhaps this shortness of breath, exhaustion, post-exertional malaise is just going to be my life at this stage and I should just learn to live with it? Is it unreasonable to think this can be fixed?


Have confidence

by Gemita - 2021-05-13 15:21:09


Upgrade of pacemaker (single, dual or CRT pacemaker to CRT pacemaker with defibrillator)

It looks as though an authorisation form has been completed for a CRT-D (three lead device with defibrillator).  It looks from the codes as though it is going to be a CRT-D (cardiac resynchronization therapy with defibrillator).  Code 33249 = insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s). Code 33233 = removal of permanent pacemaker pulse generator only.  (They will remove your present device, but leaving the two leads you already have in place and then replace with a bigger device to house an additional, third lead + bigger battery).  I hope I have got that correct.

I think you need to go back to your doctors and ask them to explain in simple terms the procedure you are going to have and ask them to explain about a defibrillator and the reasons you need this?  We usually need a defibrillator to protect us from a potentially dangerous arrhythmia or a sudden cardiac event and they should have fully explained what they were going to do and why?

All I can say Simon is that they would not be recommending this treatment plan if they felt you didn't need it or if it was not going to help you in some way.  I would go into this with hope in your heart that that third lead, together with a defibrillator will keep you not only safer but help you to live a better quality of life and overcome any pacemaker syndrome symptoms.  I believe your symptoms can be improved with CRT-D but it may take a little while to make a difference, although I do not think your ejection fraction (EF) is dangerously low, so you can afford to be patient.  However, I am sure that by helping your two lower chambers to work "in synchrony" many of your symptoms can be improved.  I attach a Medtronic Coding system to confirm the Codes:

I wish you well.

Glad you are interested in your healthcare

by Terry - 2021-05-13 19:13:15

You don't have to go to Mayo anymore for physiological pacing. CRTHP, and one lead, not two leads like the original CRT. Search "His-pacing" with your favoriet browser and become empowered as a stakeholder, along with your up-to-date EP.


by simonsimon - 2021-05-14 11:48:12

Thanks for that tip on ‘His-pacing' Terry, I spent all last night researching it. It baffles me why I didn’t get that done in the first place. I messaged my EP to see if I am a candidate for it. 

I must say how impressed and comforted by this forum and its members. Amazed at the level of professionalism and empathy I find here. Thanks so much!

Gemita, can't say how much I appreciate your support, you really do boost my confidence!

You know you're wired when...

The mortgage on your device is more than your house.

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My pacemaker was installed in 1998 and I have not felt better. The mental part is the toughest.