Replacement Delayed

I was scheduled to have my pacemaker replaced this Friday because I am on the last 3 months of the battery and he also wants to put in a third lead, but he wanted me to get an echo and Stress Test this week, both of which came back abnormal with an EP of 39% and apparently possible blockage somewhere that showed up on the Stress Test (haven't seen the results yet).  Suggested I contact a cardiologist to do a heart cath.  All this was done through his NP because I never see him or talk to him. He won't do the replacement so I tried to contact my cardiologist but he is off until Monday due to holiday.  My Pacemaker is set at 65 BPM right now, but this is very stressful.


4 Comments

Delayed

by AgentX86 - 2021-11-25 21:50:41

I can understand why you're concerned.  I'm sure they don't want to do a PM replacement, unless absolutely necessary, until they know what else is going on. Even though a PM replacement is a fairly routine procedure, ading a third lead complicates things a little.  Add to this the unknown condidion of your heart and prudence demands more information.  At this point, I think a heart cath is the right direction.  You still have a while on your battery.

I am a little surprised that your EP isn't in contact with your cardiologist directly. My doctors are/were in close communication.

The long weekend is probably stressful but it sounds like your PM battery isn't much of a problem.

Communication With Dr

by holly - 2021-11-25 23:02:04

I totally agree with you and wonder why my EP has suddenly left this problem in my lap instead of coordinating my care with my cardiologist.  Can they do a heart cath procedure when my battery is in replacement mode?  I don't know why he wants to do a third lead, NP just said it will help to synchronice everything better since my EF was 39%, but I don't know if it is absolutely necessary.  I feel kind of abandoned.  The NP is wonderful, but this EP is so busy that he can't even see me or talk with me and depends on her for that.  It's been about 2 years since I saw him.  In fact, I remember them saying because of Covid, I don't have to come in, could do video chat and also the remote shows the same reading as an interrogation by Medronic.  Also, they never called me after the remotes or sent me information in my chart so I had no idea if everything was ok.  Now here I am in this predicament.  I'm hoping my cardiologist has some answers.          

Delayed redux

by AgentX86 - 2021-11-26 01:35:40

IMO, it would be better to do the heart cath before the PM replacement but I'm no doctor.  If there is a blockage (I sure hope not, BTDT) I'd think the risk of a PM replacement, particularly with the added third lead would be higher.  It would be better to leave the heart alone until any structural problem gets fixed.  You still have at least three months on your battery.  It's better to know the whole story before the "who's on first" decision is made.

The third lead is needed so the left and right sides of the heart are synchronized.  My EP gave me the analogy of a water baloon.  Squeeze one side and the other bulges out.  Squeez the other...  With this left/right dyssynchrony the delay between the right and left pumping can cause the heart to enlarge (cardiomyopathy), like the water baloon.  When the two sides are synchronized the baloon doesn't bulge out. The compression of both sides at the same time supports both.  Though there is no way for water to get out of the baloon, the heart will pump blood to the body more efficiently rather than waste effort pushing on the other side.

The problem is the increased size of the left ventrical.  Your LVEF of 39% is a measure of this. Depending on the doctors and insurance company, 35% or 40% means that you're eligible for the third lead and CRT (Cardiac Resynchronization Therapy) pacemaker. The CRT pacemaker usually stabilizes this and often reverses it, perhaps completely. Since you're at 39%, it's still early. 

Necessary?  IMO, without a doubt. A normal LVEF is 50-60%.  40% isn't terrible but it's only going to get worse.  It's much better to catch it now while you have a better chance of a complete recovery to a normal LVEF.

Covid is beginning to be rather a cop-out.  Our hospitals have been open, albeit with no visitors, for well over a year.  I've seen my EP twice, had an echo cardiogram in that time and my vascular surgeon once with ultrasounds on my carotids (and again it two weeks).  I've seen my cardiologist at least five times since covid+0days.  I had surgery on my arm last summer and just finished three months of PT.  Hospitals know how to deal with it.  Patients are somewhat of a risk but so is the lack of health care.

I wouldn't be happy about the lack of face-to-face care and lack of coordination, I think your EP is moving in the right direction.  I know it's tough but don't get too uptight this weekend (maybe not do too much Black Friday shopping ;-) and see what your cardiologist has to say next week.  He should be in the driver's seat now.

Please don't borrow trouble this weekend and please report back to us with what you're told.  We learn as much as you.

Slowly Moving Along

by holly - 2021-11-30 23:45:54

Last week I had a nuclear stress test that was abnormal showing possible blockage.  Cardiologist is planning on doing a heart catheterization so my EP can do my pacement replacement possibly with a third lead depending on what the cath shows.  I could have gotten in this Thursday, but apparently there was a problem with too many Covid patients??  I sure hope I can get scheduled for next Thursday.  It has been difficult with abnormal tests delaying the changeout of my pacemaker which is at the end of service, but I do feel a little better with my cardiologist involved in the process.  Since I've never had a cath or a replacement, I am having anticipatory anxiety but also looking forward to these procedures being over.  

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