Bi-Ventricular Pacing risks & concerns

I am sure you will be in safe hands

by Gemita - 2024-09-11 16:05:41

Marty, just some thoughts, since I have no personal experience with biventricular pacing. 

You have an excellent history of never having been shocked with an ICD which I presume is there for a dangerous arrhythmia or to protect you from a sudden cardiac event.  I am sorry to hear about your blockages;  also the development of the rapid heart beat and SOB.

I cannot understand why you are again having the same symptoms especially as you have had the blockages cleared?  This makes me think that perhaps your doctors have seen that you are prone to difficulties from right ventricular pacing.  It is possible that they want to protect you from  pacing induced arrhythmias and to prevent heart failure symptoms from occurring in the future.

It seems you have accepted surgery which is in a week's time.   Why are you are saying 50% chance this will help?  Since you are in need of a new ICD/pacemaker, upgrading at the same time seems sensible.  As your EP and cardiologist are so confident about doing the procedure, it sounds to me as though pacing both ventricles is the way to go?  I accept placing the third lead optimally can be difficult to achieve but in experienced hands, I would be confident that the procedure will go well and the outcome will be favourable. 

I wish you lots of luck and hope that synchronised pacing will relieve some of your symptoms.

Hi 💕

by Lavender - 2024-09-11 18:23:09

I have a CRT-P. It improved my EF from 45 to 55-60% in a couple months. I was told it's better for synchrony. I wasn't given a choice so I can't compare. Let the pros decide. 

are you in heart failure?

by Tracey_E - 2024-09-12 10:40:17

If you have heart failure or reduced EF, CRT may help. It's not a guarantee but synchronizing the ventricles reduces the stress on the heart. Some doctors are faster to recommend it than others. My previous doctor recommended it as a preventative measure, my current ep said he doesn't feel it's effective as preventative, if my EF drops then we'll talk about it. So far my EF has not dropped.

If your EF is good. I would be hesitant. However if it's dropped, and both of your doctors recommend it, then I'd go with what your doctors say. 

Very anxious & hesitant about Bi-V Upgrade surgery tomorrow morning

by martyh29 - 2024-09-16 10:24:15

Thank you all for your responses. My last EF late May, was 57. I have RBBB, NOT LBBB. Chest X-ray last week showed slightly enlarged heart. Occasional mild ankle and leg swelling. Very sensitive to salt. The EP who recommended Bi-V upgrade, and his NP, said it may not help, maybe 50% chance. He stressed I'm 11 yrs older though, (now 79), and my heart is older.  This EP's comments were also based on results on 2 week Philips monitor done last April/May, that showed periods of heart block, (which was when I felt symptomatic). That was during time when my symptoms returned after LAD stent (90%), and Balloon in distal RCA (90%), were done in late March. I had 4 1/2 weeks of feeling well after that first intervention. During the second angiogram, late May, it showed the balloon failed and I had a 99% distal RCA blockage, which now the interventional cardiologist was able to stent. That was over an old stent and my  regular cardiologist says it is a tiny stent, so, I think that maybe there can be still less blood supply to that area than is optimal. And, a very smart NP pointed out to me that reduced blood supply to right side of the heart which feeds blood the SA node and AV node, and a deficit of blood in that area can cause the symptoms of palpitations I have. Also, because of these episodes being so close together, I was not able to start cardiac rehab, which probably would have helped a lot. The surgeon who is scheduled to do this tomorrow said he's just doing what the original EP who ordered the upgrade, is asking him to do. I asked his opinion re: upgrade, and his written documentation is that mine is a complicated situation and "confounded" by my having 2 blockages stented in the last 6 months. He said he can't know for sure if a BiV would help. Said it's my choice. If I don't want the BiV, he'll just replace with same type of 2 lead unit. Simpler and estimated 1 hr procedure vs. maybe 3 hrs for BiV upgrade. And, also, they want me to continue taking anti-platelet med and 81mg aspirin, right throughout, because of not wanting to risk a stent blockage. I'd think that makes bleeding more risky? It's unfair for me to have to decide which way to go, although I appreciate the honest assessment of the surgeon. One day I can walk 2-3 miles, with no problems. Another time, just a short stroll and I'm feeling my heart racing and some SOB. When my 2 week Philips monitor was on and I apparently had a failure of the balloon that treated the distal RCA blockage, (said 99% when stented weeks later),I was feeling an acute sensitivity to Ventricular pacing...like in a steady hard paced rhythm, which also showed on EKG's. Now, it's more occasional fluttering that often goes away with rest. My anxiety now and the overall psychological stress is through the roof and that can cause and/or aggravate these palpitations too, I know. if I deny the upgrade, and if I should need it in future, I'd need to do the whole thing over again. But if I say yes to the BiV unit now, it's there. Yet, I'm scared of the extra time, extra radiation (I've had multiple Chest CT's over last two yrs, and will continuously need more), longer anesthesia time. I'm almost ready to call the whole thing off but that will only make my anxiety even worse! One last thing...11 yrs ago, I was "talked" into this ICD, which was done after I developed RBBB, and they induced my heart to stop. That 1st clinic was terrible in all follow-ups. I found a new clinic, where I've been for last 10 yrs, and where  I'm scheduled for this procedure tomorrow, and they are fabulous. I was told by the same EP at this excellent clinic, 10 yrs ago, the same doctor who suggested this BiV upgrade now, that he felt I probably never needed an ICD at all 11 yrs ago. And of course, I've never been shocked and less than 1% paced total, until V pacing began this past March, as a result of blockages. So, this EP was apparently correct. For the last 11 yrs, I've lived with an anger about this situation and it's eliminated certain hobbies I have and other situations, eliminated MRI's, and increased my general level of anxiety about travel and so much more. For yrs, my current ICD was in a sort of backup mode, initiated by the excellent clinic with lower pacing rate of 40. My heart's average was mid 40's to low 50's. That was reset by the new excellent clinic and doctor. I was told to walk each day, let my heart do its own work, and not to be paced continuously, (like the 1st clinic that talked me into my ICD had me...a constant 60 bpm, with a motion detector mode that made it shoot up faster with any motion and it felt awful). I'm  an intelligent and scientifically educated person, and understand these issues well, which, paradoxically, makes it harder!  Now I have less than 24 hrs to make my decision. Any more thoughts that might help me, ASAP, due to the time frame, would be greatly appreciated! (Sorry for such a long post but wanted to spell this out as best as I could). 
Again, thank you all!!!

Marty

Oops, a few more comments/thoughts!

by martyh29 - 2024-09-16 10:52:11

I'm hesitant to be paced full time if I don't necessarily need it. I had a conversation with an acquaintance who is a cardiologist who said he didn't think it was needed and might not help because from the facts I told him, said if I'm not in heart failure, it's not necessarily indicated. But he's not my regular doctor, and not an EP, but, I'd say, overall a very, very smart doctor. However, the current EP who suggested the BiV upgrade saw some episodes of dyssyncrony and thought if that occurs, a BiV would make both ventricles beat at the same time and relieve symptoms. But, those bad symptoms with the dyssyncrony were essentially during the period when the distal RCA balloon apparently failed and several weeks later it showed there was a 99% blockage there. I'd think that it had to have been developing or was already there during those time periods of dyssyncrony? No one can know for sure and the only way to see now would probably be another 2-week Philips monitor but I'm near battery depletion so that would only delay things. Also, in the "patient info booklet" online on one of these BiV units, (possibly Medtronic?), it states that this unit should not be used on patients unless they have "heart failure that no longer responds to medical therapy" [paraphrasing - can't find it now for exact wording]. That scares me, since that's not descriptive of  my situation. The NP says they're just recommending this because of the symptoms I presented with. Those symptoms were worse during the period before the 99% blockage was stunted. My current ICD is Abbott (company was St. Jude's Medical, before being bought by Abbott). They said they'd most probably stay with the same brand).

Thanks again!

Marty