Questions for surgeon

Hi everyone,

I think this is the greatest site ever for those of us who have or plan to have devices to help them. I'm 91 years old and on my 4th dual chamber pacer. The last one was placed in March, 2020. Recent cardio testing (Echo's etc) have shown the need for a biventricular pacer. I'm convinced this may help because I do have shortness of breath, sweollen legs and ankles and the tests show 45 percent fluid in my lungs. I have cardomyopathy and controlled glaucoma and kidney disease. Basically, I'm a "healthy" 91 year old and even though I walk with a walker, I';m still involved with life. I walk, excercise, read books (even write novels), drive short distances (even without functioning rotator cuffs) watch movies with my wife and basically have a life. My medical records were sent to the surgeon who placed by last pacer and I plan to do the surgery with him. I've lost some weight over the past year. Nothing significant but part of existing pacer shows some portions that are only covered by thin skin. Doctors felt it would be a serious situation if the pacer or leads popped out and I agree. I have a telephone appointment with the surgeon next week and have some questions prepared. I was wondering if any of you, based on your experience would add and questions or issues that should be addressed before the surgery is scheduled: at Palm Beach Gardens Medical Center. Briefly, my questions are:

Based on several doctorsrecords what’s your plan for the surgery—CRT-P ,or CRT-D? Should I be able to tolerate the procedure? I’m 91 years old—does age influence the outcome?

Will the existing right atrium and ventricle leads have to come out? They were placed almost 35 years ago. You placed dual chamber pacer on 3/25/20

A rhoracic surgeonsaid there was only a thin covering of skin on my present pacer—His plan (before testing showed I needed a biventricular pacer) was to move it with the existing leads—create a large pocket and place it about under pectoral muscle one inch below my chest. Your plan?

Estimated ime for surgery? Recovery time? Anesthesia?

I suffer from serios anxiety and panic disorder—meds to alleviate.?

Settings—BPM?

Thank you for any input

Richard B.

 

4 Comments

91yo and fit!

by AgentX86 - 2021-10-26 23:02:50

I'm impressed! You seem to b doing pretty well.  Fluid in the lungs could be caused by the heart or kidneys (or likely both).  My mother was in a similar place about your age.  There is a tightrope that she had to walk between drugs for the heart and those for the kidneys.

It sounds like you're in heart failure, again not that surprising at your age.  "Heart failure" isn't good but it's not as fire as the name implies.  In short, it means that your heart can't pump enough blood to pump all of the fluid out of your feet and lungs.  You can see why kidney problems exacerbate the problem.

As long as they're working, it's unilikely that the existing leads will have to come out.  They'll simply have to add the third lead and replace the PM.

Puting it under the pectoral muscle will extend the recovery somewhat but it's probably a good idea. Asking what anesthesia will be used is a very good idea but it's likely that your PM won't know.  That sort of thing is usually up to the anesthesiologist.  You should have a say in it (local only, twilight sedation, or general anesthetic) but they may have good reason to limit sedation.  I only had locals but I'm a bit younger than you (65 at the time) and I'd had a bunch of heart and carotid procedures under locals so they weren't too concerned that I'd freak.  I'll say that making the pocket *hurt*.  I can't imagine implanting under the pec with only a local.  Given your problems, they may not want to use a general, either.  I wish I'd have asked more questions so I knew what to expect.  I had no problem with the surgery and recovered far faster than I had expected but knowledge is power.  There is no way that they could have predicted how fast I recovered or how slowly any other patient will.  There is just too much variablity.   They'll tend to estimate towards the worst case so patients don't freak before or after, when things aren't perfect right away.

You have very good questions but most of the PM specific questoins probably can't be answered before surgery.  They'll have to tune everything to meet your needs.  You should ask what th settings are, after, so that you can compare them each time you go to the device clinic.  You can then see what they're fiddling around with and ask "why?".

questions

by Tracey_E - 2021-10-27 08:45:46

First question I would ask is are they planning to use the existing leads. If they are still working, they should be able to simply add the new lead and reposition the box. 

Do you know what your ejection fraction is? If it's dropped, sometimes getting the ventricles into sync can help bring it up. It can't make the heart beat harder, but it can make it more efficient. 

As we've discussed before, if they want to remove the leads rather than add a new one, there are a lot more questions to ask. 

Are you staying with the cardio-thoracic or using an ep? 

Gonna message you in a minute. 

Questions

by Rxrich - 2021-10-27 15:31:52

Thank you,  Agent X and Tracey for your input. At my age I'm concerned about any surgery but if this procedure will improve my quality of life with reasonable risk, I'm all for it. Yes, an ep will be doing the surgery and the first question will be: Are you going to leave both leads on the right side and add a lead to the LV? Those leads were placed almost 35 years ago and survived 4 pacemakers..

Since they are still working and the same ep used them when he placed by last dual chamber pacemaker in March, 2020,,and based on both your comments, I think he will keep them and just add a third lead. That woould make me feel better about the procedure since I do have anxiety issues. However, I'll get those answers during my telephone appoint ment with him next Tuesday.

haven't checked my ejection fraction numbers lately (and will) but last I heard it was pretty stable and not dropping. After leaving the leads in, I think the only difficult part will be placing the third lead htrough the vein and across my hear to the LV.

I made the choice to have this surgery based on quality of life. I'm 91 but have always been active physically and mentally. I've skied down mountains, sailed oceans and enjoyed nature so I've had a full life--so far. However, recently my life has taken a new turn. I'm glad I'm still living on this planet and there are still things I enjoy. Reading, writing, friendhips etc.But now I have shortness of breat with slight exertion, swollen ankles and legs and a part of an existing pacer that's only covered with a thin layer of skin (probably due to some gradual loss of weight based on diet)

So, for me there's no downside as far as the surgery is concerned. I'm grateful for what I have now, so there's no real risk. I've already lived a full life--any time I have ahead of me is a bonus. I want to stay involved with life. It doesn't mean I always have to be doing something.allm the time. I can sit outside and listen to the birds---that's okay too. Youth can take place at any age. 

I'm actually looking forward to the surgery so I can put it behind me, recover at home, get better and be able to get in the pool and even the ocean---well, maybe not the ocean but the pool is okay.

Thanks again,

Hmmm

by ROBO Pop - 2021-10-28 20:55:32

Sounds like from the symptoms you describe you have congestive heart failure which dictates a CRT-D. Now I want to be clear, it's a crap shoot whether it will help with your symptoms or not, mine didn't butt, and I have a really big one, it will almost assuredly sliw the progression of the disease. Take the word of a guy who has been living on borroeed time for 15 years with a train wreck for a heart...go for it. Quality of life is what really matters

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