My son

My son has a Medtronic pacemaker 2 leads.  His cardiologist wants to do an echo to see the efraction ratio. He said that if it's under 50 they will need to put in a third lead. I don't understand why the efraction ratio would go down and is this life threatening? Does anyone have any advice! 


Sometimes people need 3-lead pacemakers

by Gotrhythm - 2022-05-22 14:08:00

The ejection fraction is fundamentally a number that talks about how efficiently a heart is pumping. It's a way of expressing how well all the parts, both on the left side of the heart and the right side, are working together. The lower the number, the less efficient.

Although the heart has 4 chambers, an atrium on the top and a ventricle on the bottom on each side. A 2 lead pacemaker, only puts one lead into the right atrium (the top) and one into the right ventrical. For many people that 's all they need.

But for some people, it turns out that the right ventricle and left ventricle aren't able to coordinate, to work together with a lead on only one side. They get out of sync. The echo cardiogram allows the doctor to look directly at the chambers, and the valves. To see how well they are filling and how well they are squeezing. If they aren't squeezing together, i.e. they are out of sync, you get a lower ejection fraction.

A third lead is put into the left ventricle in that case. Now the pacemaker can be programmed to make both ventricles work together, in sync. Just so you know, a 3-lead pacemaker is called a CRT device. CRT stands for cardiac resynchronization therapy.

Is it life threatening? Well, think about how your car handles when the wheels are out of balance. Is it an emergency, no. But your tires are going to wear unevenly, and you're not going to get the life out of them that you should. Eventually there will be enough wear that you will have a real problem. Same thing with the ventricles. They need to be balanced so that there is not excessive wear on one side.

I'll let someone else comment on the doctor's choice of 50 as the ejection fraction number to look for.




by AgentX86 - 2022-05-22 18:55:29

Considering that 50-60% is normal, a cutoff of 50% for CRT pacing is quite conservative. Generally they don't consider CRT pacing until it goes under 30-35%. I don't know how they do things in the UK but no one in the US with a LVEF of 50% would get a CRT pacer, at least for EF reasons.

Threshold for CRT

by SeenBetterDays - 2022-05-23 08:33:14

I feel like there is an inconsistency of approach between cardiologists.  My EF is 45% and they seem to want to monitor rather than intervene.  I am unsure why the guidelines are 30-35%.  Is it to avoid the risks of surgery and placement of an additional lead?  In this instance 50% seems a little high but perhaps there are other factors to consider.  Is your son feeling unwell as I think that it would definitely warrant further discussion with the cardiologist before moving to a CRP device especially if he is not symptomatic.  


by AgentX86 - 2022-05-23 12:12:48

I think the guidelines are where they are is that above 30-35% there is rarely any problems and in most cases will level off. It's a matter of risk/reward and, frankly, resoures ($$). Yes, there certainly are other reasons for CRT pacing other than LVEF. I have one even though my LVEF is 55% and hasn't changed.


by PacerRep - 2022-05-24 20:27:32

This is very confusing to me; a 50% EF doesn't correlate to a CRT device anywhere in the world. I, unfortunately, have to conclude that something is lost here in translation. What else can you tell us?

been there

by dwelch - 2022-05-27 22:21:41

So my first pacer was at 19 after watching my heart for years.  My ef was under 50 then and still is now.  Fast foward almost 30 years with LV pacing, about mid way through that they should start doing echos every year if not twice.  If your doc wants to start them now, then take them if you can.  Why not.  We watched mine over time pass 40 and then when it got into that 35 or lower range it was time.  In my case we went with a biventrical and the next echo showed not only did the drop stop but it went back up.   Now we all have different conditions, but under 50 seems very conservative, but it may be related to your childs condition.  It still seems like way to big of a number, under 40 okay under 35 yes, but 50, ehhh...

Normally the heart sends the signal to fire the mucles more from the middle so that electrical wave goes out evenly, balanced.  But firing the heart from the left side creates an unnatural wave and the one side gets a stronger signal than the other.  So over a long period of time, I think I have read 15 years of pacing it could cause something like this.  Now just today reading some other questions, sounds like HIS bundle vs biventrical are options.  I was not given that option and dont really care, I trust my doc, I go with what she says.  I know a ton more than she does about the device itself, she knows a ton more than me about the heart and body.  I had a broken lead from the replacement of device number 1 and that was capped so I had two leads over 30 years old and one over 20, one capped. had three using two.  Then they managed to get a fourth one in there so I have four using three on one side.   Im a big guy.  So that is another factor.  They can tunnel a lead across the chest and down the other side if needed.  WHEN the time comes that is a more important conversation, what if there isnt room for a lead.

You should get the echo either way, and maybe if your child is new to pacers dont need one every year, but maybe between device 1 and device 2 or certanly after device 2, if they are not already doing them, ask and or find another doc.


3rd lead

by islandgirl - 2022-05-30 20:28:56

I had a 3rd lead added in January 2022.  My EF was 40-45% but a portion of my septal wall was not moving and the EP could not synch the ventricals.  After lengthy justification with the insurance company and at the end of the battery life, my device was upgraded.  He said they are strict with the 'below 35% EF' rule for upgrade, particularly if your device battery is not depleted.  My EP said there were no long-term studies showing the 3rd lead improves the heart function, but he fought hard for me as he felt like my heart function was worsening.  With the 3rd lead now I am feeling better, and my EF is 45-50% and not as much symptomatic pounding.

My son

by Angferrer - 2022-05-31 14:03:02

Thank You for all the responses! I truly appreciate it  as I am a nervous wreck every time they tell me they have to do something else! My son got his Pacakwr when he was 9 years old! He is now 19! When they went in to replace the old leads they had a hard time because there was a lot of scar tissue. The 6 hour surgery turned into 12 hours! That was hell!!!! They got them out but one broke and they had to leave a tiny piece of it in there. After the surgery he got blood clots. He is ok now. It's been a year since that surgery and now they want to put in a third lead. Does anyone else have similar stories?

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