CRT-D for Low EF
I had a heart attack 13 years ago (49), took about 6 months to start feeling right but heart rate/blood pressure always remained low, like high 40's low 50's and 100/70. Year after year Cardiologist never said much other than things looked great. Had a near-syncope 4 years ago while eating breakfast. Put on Holter and after 2 weeks recorded another VT, it stopped spontaneously in about a second and I felt momentarily light headed. Echo, stress test, catheterization, EP test and ICD within 36 hours. Dual lead, Boston Scientific D142 and 80 mg Sotalol twice a day. They set my heart rate to 70 BBM to reduce likely hood of VT. The past few months I've been feeling slightly light headed and not so great but could still excerise and play golf so didn't do anything. In August 2021, got stung by a hive of bees and went into anaphalaxis. They did EKG in emergency room and Doc told me I had LBBB. At next cardio appointment they did an Echo found EF <= 35%. Put me on Entresto but I can only tolerate the beginner dose. On treadmill test, LBBB kicks in at 80 PPM. Now they want to put in another lead and pace left ventricle. Since Nov when I started Entresto I've had day's where I feel pretty crappy, light headed, fatiqued. Cardiologist says CRT-D might do the trick. Can anyone relate to this and share their experience?
3 Comments
CRT success rate
by Aberdeen - 2022-01-03 18:26:22
Miker, I had a dual lead pacemaker implanted in January 2020 for bradycardia. Heart rate 35-40bpm. In May 2020 I collapsed at home and it was discovered that the pacemaker had caused the left side of my heart to become out of synchronisation with the right. I had a very low ef. I had a CRT- pacemaker implanted.
In October 2020 I had an echocardiogram which showed my Ef was 63%! This years scan showed an EF of 60% which is still very good. (I am 66 years old)
I wish you every success with your CRT-D. Please let us know how you get on.
Post CRT-D Implant Update
by miker - 2022-02-05 09:30:05
The operation was pretty easy, came home the same day and went to work the next but mostly sitting at a desk. It was a Boston Scientifc G447. First few days I was impressed that my usual occasional PVC's and PAC's had been reduced. I was not expecting that. Shortness of breadth seemed better and overall felt good.
5 days later went for a check-up and they found the lead had moved about a milimeter. The tech changed the area the pulse was coming from on the lead in the LV, took an EKG and showed me the change. That day I had a run of PVC's from 3pm to 9pm, next day the same, third day a run from 5pm until 7am next morning. Woke up once to use the bathroom and they were still running. It's Saturday now so I'm on my own until Monday. Had been excersizing again since day 4, mostly waking up an incline on a treadmill but will probably stop that until I get the PVC issue resolved. I read an "UMBRELLA" study that suggested a high PVC burden can reduce the effectiveness of BiV.
I'm hoping they will settle down over time when my heart gets used to the new device and wire.
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LBBB
by AgentX86 - 2022-01-02 18:06:17
A one-second VT isn't anything a cardiologist would burn his hair over. Less than 30seconds is classified as "non-sustained VT" or NSVT. So far, you're OK (blood pressure is low) but that near-syncope should set fire to their hair.
AN EF of <35% is bad enough, though not life-threatening yet, that the third lead is highly recommended. The low EF is often caused by the two-lead pacemaker. Since only one ventricle is paced, the ventricles get out of sync sometimes causing the heart to enlarge. This is called "pacemaker induced cardiomyopthay". The correction is the third lead to resynchronize the ventricals (called "cardiac resynchronization therapy" or "CRT") so the heart beats more normally. The third lead will reverse this process in many and the EF may even come back to normal. This isn't guaranteed but it should at least stabilize your EF.