Ejection Fraction

Give it a bit more time

by Gemita - 2021-06-30 16:26:32

Roger, I have been following your progress and I can see that you have had many hurdles to overcome.  I look at it this way, your ejection fraction hasn’t gone down, it is stable, and this is quite an achievement considering how many problems you have had to deal with.  Three months is early days with CRT therapy and in any event, your body could still be suffering from the trauma of the CRT procedure itself.  

Although sometimes CRT can result in immediate improvements for some patients, for others I believe it can take much longer than three months to see any results and may even continue to improve for up to a year, so I wouldn’t give up hope just yet Roger.

You do have heart failure and your doctors are trying everything possible to help you.  The CRT therapy hopefully will enable you to live a quality of life with your condition and to help you to control any symptoms you might have.  It has to be said though that pacemaker/CRT therapy is sadly not a cure for heart failure and your doctors may need to trial a combination of treatments (lifestyle/medication) to get the right balance for you.  I still see the CRT therapy as a potential benefit to you.  Give it a little longer Roger and move forward with hope in your heart.  I am keeping my fingers crossed for you.

give it a bit more time

by Roger A - 2021-06-30 21:11:00

Thank youi Gemita, 

I know its been only three months, I guess I was expecting too much too soon.

Thanks for the encouragement 

Ejection fraction

by Aberdeen - 2021-07-01 12:38:46

Roger, I had a biventricular (CRT) pacemaker implanted in May 2020. At an echocardiogram in October my low ef had improved dramatically. I had a couple of spells in June and September when my low heart rate went to 110 and I felt very unwell. A and E visits each time. From September on I have felt very well (touch wood)! so my ef could have improved after 5 months.

I hope your ef improves soon. As Gemita said- give it time. 

CRT or biventicular pacing outcomes

by Selwyn - 2021-07-01 17:29:24

Hi Roger,

It is always difficult to  listen to individual stories as they may not be typical of outcomes. Large numbers of people having CRT for heart failure benefit. The outcome has been measured at various times, the shortest being 6 months, though most are 12 months to 2-5 years.

I am pleased to say that you are in this for the long run. Know that you have the best chance of a good outcome with CRT, studies have been carried out over years.

Don't be looking for individual cases as either way they may not be typical. Most studies use many hundreds of people with CRT. We still fly knowing that airplane crash, however, we are reassured by being in the safest group.  It takes many months for the heart to re-model ( when this happens).

My own cardiologist had me back in 1 year for a repeat echocardiogram to try to show re-modelling, though this was not for heart failure. I continue with yearly echocardiograms.  It seems that most consultants think one year is a reasonable review period though I am unsure that this is based on science.

CRT non-responders

by asully - 2021-07-01 22:01:47

While many patients expierience reverse remodeling, not every one does.  It depends on the type and extent of the damage to the cells in your heart.  Even if you don't reverse remodel it may improve other factors or slow worsening hf. So far I am in the non-responder group and my heart function has declined since the start of my CRT.  I do believe we would have seen an even faster decline had I not opted for crt.  In chronic heart failure squeezing every last drop out of your hearts ability to compensate is very important.  My crt started in December and we are doing another echo at the end of July "just in case" I show a delayed response although in my case it is unlikely.  I know that remodeling has been known to occur up to a year after crt starts so be grateful you haven't declined and be patient.

ejection fraction

by sandoval - 2021-07-03 21:38:48

Can I ask if people posting here are paying patients? I had a CRTD 6 months ago but never offered an echo on NHS and not seeing a cardiologist until November.  Is 3 - 6 months standard for an echo after a CRT ?

ejection faction

by AgentX86 - 2021-07-03 23:20:00

You must have had an echo before the CRT as a baseline.  Six months is reasonable for a followup echo, to see if there is any change.  It doesn't happen overnight.

Paying? We're all paying, some directly, some indirectly. I had a GABG in 2014, three ablations in 2017/18, and A/V ablation w/CRT-P in 2018.  I lost count but the charges are up to around $500K, which my insurance paying about 50-60% (contracted rate).

I had appointments with my EP every month, then three months for the first year, then six, now once a year.  I have had appointments with my cardiologist least every three months since 2014.  I get an echo if my heart and carotid (separate appointments) once a year and see my vascular surgeon once a year.   I also have a neurologist, who I see every six months and a rhumatiologist who I see once a year (no issues, now, but doctors have to see patients once a year to prescribe meds).  I was also seeing an endocronolist but graduated from her care.

Yes, it's "private" (employer sponsored) insurance.  My cost of the insurance is about $4500/year (for two of us) plus deductibles, copays, and (discounted) meds.  It's not cheap but very good.  For most of the care, I go to a major teaching hospital.  I will be going on "government" insurance (Medicare) in a couple of months but the process  is similar, just the government pays part of it instead of an employer.

Sandoval

by Gemita - 2021-07-04 03:04:05

Sandoval, as you know, I am in the UK too and I am not a private patient.  My medical care for all my conditions is covered under our National Health Service, although we pay our taxes of course.  

From what I have read here and from my own personal experience, echocardiograms in the UK don’t seem to be offered routinely or regularly unless there is a clear need for an assessment of heart function.  Symptoms like breathlessness, chest pain, difficulty with exercise, extreme fatigue, especially with known heart disease either structural or electrical, would prompt the need for further investigations for example.  My doctors do not routinely offer an echocardiogram because I have no structural heart disease and my electrical disturbances although still continuing, are well controlled and stable.  

So to answer your question, is 3-6 months standard care for a follow up echocardiogram following CRT, I would say this would depend mainly on your symptoms, but at 3-6 months following CRT, it would seem to be beneficial to receive an echocardiogram as patients can show both continuous improvement as well as deterioration after the initial response.  Checking ejection fraction earlier may be a waste of time and money since EF may be slow to show a change or respond to treatment.  If you are symptomatic however, with worsening symptoms after CRT implant, I would think a responsible doctor would want to carry out frequent health checks, including ordering an echocardiogram.  If I recall correctly, you attend a London hospital.  There is no harm in asking whether you could have another echocardiogram under the NHS to see how well your ejection fraction is responding to treatment, particularly if you are getting any troublesome symptoms 

Sandoval

by Aberdeen - 2021-07-04 04:35:42

As I live in Scotland my treatment is covered by the NHS . I pay tax. My echocardiogram which was done after 6 months will be followed by one a year later as fortunately the result was that CRT had been beneficial. I am very grateful to our NHS! 

34 years

by dwelch - 2021-07-04 10:48:49

34 years with pacers, on device number 5 which is a biventrical.  CCHB.  

After 15+ years LV paced you can start to develop problems and I started getting echos ever year.  It was not until a few years ago (30 years in give or take) that my EF dropped down far enough to be time for a bi-ventrical.  

I was told a few things and based on my last visit I think the doc contradicted herself, but whatever it seems consistent with the above.   Need 6 months to see if there is a response, I think three is too soon,  I hope assume the doc is going to keep up with echos for you every 3 or 6 months and then depending on the result once a year after that.   I was told that it may not improve but this is supposed to keep it from dropping further (if being LV paced for decades was the problem).  Mine did improve several points.  

I am in the US with an insurance plan that covers most of this stuff with an annual deductible.  Office visit with interrogation, echos, etc fall into that category, this current doc is on the agressive side of for example having more phone checks as the pacer gets closer to replacment (dont use that phone box anymore so will see)

Hopefully your next echo will either show no further drop or possibly an increase.  

Ejection fraction

by sandoval - 2021-07-04 21:41:49

I had an MRI last year which showed EF of 15% and lead to the CRT D in January but nothing since the implant. Only symptoms apart from a fear of stairs seems to be a weird heart rate that can be 120 one day and 60 the next - tried Ivabradine but deep breathing seems to work better. I  had a 24hr holter monitor but not heard anything about results. Only see my cardiologist on the operating table (twice in 15 months) and as 6 months have gone by will try to get an echo arranged. I can get "paced" quite easily but going further up the food chain is very difficult.

3 months is considered early, 6 months is usually a good benchmark

by asully - 2021-07-05 05:39:07

I had one done at 3 months but only due to worsening symptoms.  Had things not changed so dramatically for the worse I wasn't scheduled until 6 months.  Usually my docs do an annual echo when I have had recent instability, biannual when I am smooth sailing, and as frequently as every 3-6 months if symptoms are getting worse.  After any surgery they usually want to do one around the 4-6month range (as many others have said 3 months can be too soon to see any big changes).  I am not familiar with NHS but I imagine they have standard operating procedures that allow for echos when symptoms are concerning.