Biventricular pacemaker

I had a biventricular pacemaker put in about 5 years ago when my his bundle pacemaker failed.  I am just curious about how they got a biventricular pacer approved and paid for by my insurance.  I had thought that you needed to have a certain degree of heart failure and a low ef (neither of which I have) to get these devices approved for implantation.  I do pace over 90% in the ventricles and I am young (44), so I wasn't sure if something like that could get approval alone for this device.  But as I've been reading up on it, I have never read about anyone who has received a crt device based on that.  Just curious, if anyone else has a bi-v and recieved it just because they pace a lot in the ventricles. 


5 Comments

some doctors do it that way

by Tracey_E - 2022-05-04 09:46:06

Some doctors feel that doing the bi-ventricular pacer will prevent heart failure from pacing. It's not common, but it's not unheard of. Most doctors start with the simpler pacer then wait and see how we do. Did his pacing not work for you or did the pacer itself fail? 

I've been paced 100% since before bi-ventricular pacers were a thing. When I had my last replacement, my cardiologist suggested I might want to upgrade. I did some research but decided not to get it because I have very old leads and don't want to mess with them. If one of them fails and I need to extract and start fresh, I thought that would be a better time to consider an upgrade. My doc agreed with my reasoning. I later got a new ep who said if I haven't had a problem yet odds are I won't, so an upgrade would be extra unnecessary hardware in his opinion. 

So doctors are mixed, but if your doctor feels it's a better choice then insurance is likely to go along with it. The rules for EF dropping to qualify are for people who are not already paced. If your previous pacer wasn't doing the job, adding the extra lead was a good idea. 

CRT

by AgentX86 - 2022-05-04 10:21:15

The fact that you had His pacing and now that it failed, he wants you to go to CRT pacing tells me that there is something else going on. It could be that your EP is very conservative but, as you point out, your insurance company isn't balking. Ask why, if only to satisfy your curiosity. I always ask, at the time, unimportant questions but the answers often lead to better questions or another rabbit hole to explore (a maze of twisty passages, all different).

His pacing

by JaneJ - 2022-05-04 10:21:52

Thanks for the insight ( :   They tried his pacing after I broke my ventricular lead I had in.  They extracted the v lead and put a his lead in.  It had moderately high thresholds after they placed it, which is fairly common, but at my 4 week check up the threshold went up even higher and it was found that it wasn't capturing at times.  Due to the high thresholds I would of drained the battery in about 1 year.  So they pulled the new his lead and tried to reposition it again and found the thresholds were still too high, so they put in a biventricular.  In hindsight, I wish they would of just put a ventricular lead in again, as I tend to clot very easily and clotted up my inonimate and subclavian veins severely after surgery.  I would of clotted even if they just placed a ventricular lead, but the three leads really clogs the veins.  Oh well, grateful the biventricular pacemaker works and I have a decent amount of battery life ( :  

CRT

by AgentX86 - 2022-05-04 10:44:29

I'm surprised that they didn't anticoagulate you at the time.

Maybe, given your history of lead implant failure,  CRT was done as insurance?

Anticoagulant

by JaneJ - 2022-05-04 10:57:43

They did anticoagulate, but they knicked my femoral artery during the procedure, while they had the temporary pacemaker in.  So I had a massive bleed into my pelvis, so anticoagulating was tricky, as they didn't want me to re-bleed.  Was monitored in the ICU for about a week and they did end up starting heparin in the icu and I also had interventional radiology go in and clean out the clot a bit, which helped to open up the veins a bit.  It was later on found that I had a protein s deficiency, which contributes to the tendency to clot.  Not fun times for me, but glad everything in the end worked out ok 👍🏻!

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It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.