Relocating ventricular lead to RVOT?

Wishing to get some outside input.

I am trying to find out if anyone has had their right ventricular lead removed from the apex and relocated at the right ventricular outlet tract (RVOT)? Based on the studies I have read, this location does not lead to intra-ventricular dys-synchrony.

I wish to have the lead relocated is because of the possible development of pacemaker mediated cardiomyopathy or dilated cardiomyopathy (DCM). The reason I feel that I have developed pacemaker mediated cardiomyopathy is because of the length of the implant (1997), over 15 years now; a 100% pacer (rate responsive); implantation at the right ventricular apex; and a decreased EF. I have had 5 echocardiograms in the past three plus years. They have ranged from 25% in 2009 to 40% in 2010 and now I am at 30%. The 25% reading was during an atrial flutter episode which was ablated. I have a pacemaker because of complete heart block.

To complicate the issue, a bi-ventricular pacemaker is not being considered because I do not qualify. Even though my EF is at 30%, I am still in good shape at age 59. I am asymptomatic and non-ischemic. I exercise by running 15 to 20 miles a week and recently ran a sub 10 minute mile. I do not have signs of pulmonary edema or swelling of the ankles. Further, I make sure my weight is kept at a reasonable level. I am not in heart failure.

My cardiologist feels the medication I take, 50 mg/day Coreg plus an ACE inhibitor is the best approach and should maintain the EF within a range of 30% to 40%. I do not have his confidence in the medication and am very concerned that the heart will continue to degrade and the EF will drop even further. Not the scenario I want.

I have discussed this issue with my cardiologist and the response is that there are no studies that back up relocating the lead as a plausible solution.

I will add that I wish to stay in a dual chamber pacemaker because of future cost considerations. The same reason I do not wish to have a defib.

Can anyone comment? Thank you.

Richard

1 Comments

long term pacing

by Tracey_E - 2012-10-14 05:10:45

I also have CHB and have been paced about as long as you, since 1994. So far my EF is holding steady but I've given some thought and done some research for the day it starts to drop. As long as you're asyptomatic, I'd leave well enough alone and continue to do what you're doing- take care of yourself and keep an eye on it. Lead extraction has come a long way but is not without risk so for myself, I would not choose to extract unless 1) a lead went bad and it's not optional or 2) lots of evidence it's going to make an improvement. Right now, I don't think that evidence is out there. I'd probably wait it out until you qualify for a bi-vent, which is the best way to increase EF at this time.

You know you're wired when...

You fondly named your implanted buddy.

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