Update From My Previous QRSD Post..

Thank you for the update

by Gemita - 2024-05-29 07:53:15

USMC-Pacer, there is something to be said for leaving well alone.  Sometimes watchful waiting is a good option too!

I am glad they found the QRS duration better without the need for intervention.  Yes machines can get it wrong and there can be differences between operator experience too and an ECG is only a snapshot anyway of what is happening at the time.

The Rate Adaptive CRT seems to be working well for you.  I gather this algorithm optimizes CRT pacing every minute whether AV conduction is normal, prolonged, or blocked.  It adapts to meet the constantly changing needs of CRT patients because it responds to what we are doing and automatically decides when and how to pace the heart. 

The AdaptivCRT Algorithm has two different modes at least for Medtronic:

AdaptivCRT LV-only pacing occurs during normal AV conduction when the heart rate is less than or equal to 100 beats per minute. It also optimizes A-V timing and minimizes right ventricular (RV) pacing.

AdaptivCRT BiV pacing occurs during prolonged/blocked AV conduction or when the heart rate is greater than 100 beats per minute. It also optimizes A-V and V-V timing. 

Anyway, really all very positive news, especially the reverse modelling.  You are clearly helping yourself so continue doing more of the same.  

QRS

by Lavender - 2024-05-29 21:39:18

My QRS is 218ms. I questioned the cardiologist and he said the usual, "Don't worry about it". 

Lavender

by USMC-Pacer - 2024-05-29 23:07:30

I would push to have adjustments made. 

What is your CRT percentage?.. It should be on your report. Mine says something like BiVP%

The higher the better. If your QRSD is that wide, it could indicate serious dysynchrony that could be AV (atria ventricular) or VV (ventricle to ventricle) related. 

I think I've seen you post before that your EF is fairly good... in the 50s?

I've read that a wide QRSD and dysychrony can have an adverse result on heart function. But if your EF is okay, maybe the DR is right not to worry about it.

It's tough without knowing if you are LBBB or RBBB, or both. 

I suppose if your heart function is okay and you feel okay, then maybe QRSD doesn't matter in your case as the CRT will keep you synchronized? 

Report

by Lavender - 2024-05-30 11:38:48

My estimated left ventricular ejection fraction is 55-60%.
I have had LBBB for about14 years. 
Atrial paced is 38%
RV AND LV are 100% paced

The cardiologist just said that it takes longer for the signal to go around. 🤷🏼‍♀️ I did express to him my long QRS concern. 
I read this online: 

Ventricular pacing, however, results in a wide QRS complex...

In addition to stimulation artifacts, ventricular pacing yields wide QRS complexes with LBBB morphology (i.e left bundle branch block appearance). This is explained by the fact that, as in LBBB, the left ventricle receives the depolarizing impulse from the right ventricle (where the pacemaker delivers the pulses). The depolarizing wave spreads outside the conduction system, which is considerably slower, as compared with impulse transmission within the conduction system (His-Purkinje network).

You're fine!

by USMC-Pacer - 2024-05-30 14:59:51

With that EF you have nothing to worry about. I am also LBBB with pacing induced cardiomyopthy. I had the CRT implanted a year ago for same. Hoping it continues to improve my EF which at a low was 20%.. Now it is 45% and hopefully rising :) Currently I can do whatever I want (cycling, heavy weightlifting, etc) with NO symptoms so I can't complain.

Thanks for responding :)