Excessive RV pacing

My cardiologist say's my RV is pacing 95% or more and it will likely lead to congestive heart failure by which time I'll be too old for a heart transplant.

Has anyone else been told this?

9 Comments

hmmmm

by boonda2199 - 2011-11-09 01:11:40

what is RV pacing i have congestive heart failure sorry im new to all this well i have had my ICD for 9 years but new to the web site

brenda

RV Pacing

by ElectricFrank - 2011-11-09 02:11:29

RV pacing means Right Ventricle Pacing which is what most of our devices do. Any of us who have complete AV block will be pacing near 100%.

As for it leading to congestive heart failure that is an issue where there is a lot of controversy. Use of a 3 lead pacer to pace both right and left ventricles shows promise in patients with existing CHF. The question is whether single ventricle pacing is a cause of CHF or whether it was already developing and would have occurred without the pacer is still not clear.

You may get a response from some of the others on the forum who have been upgraded to a 3 lead pacer to treat CHF. It makes a lot of sense that the more natural timing of a bi-ventricular pacer would increase the pumping efficiency of the heart, which would be a real help to those with existing CHF.

frank

Well known complication

by golden_snitch - 2011-11-09 02:11:39

Hi!
Haven't been told this personally, but it is a well known complication of right ventricular pacing. Just google heart failure + right ventricular pacing. If you have complete, permanent heart block there is nothing that can be done about it, because you need the pacing. But what can be done is to switch you to a bi-ventricular pacemaker. The heart failure that is caused by right ventricular pacing is as far as I know due to asynchroneous pacing of the heart chambers. With a bi-ventricular pacer the synchrony can be restored.

If you have intermittent heart block only, so it happens occasionally, there are a couple of things the cardio can program differently in your pacer. He could for instance prolong the AV-delay, so give the AV node more time to work on its own. Most patients with intermittent heart block pace way too much. My pacer has a special algoritm to prevent too much ventricular pacing. Without this algoritm, if they'd put me in a normal DDD pacer mode, I'd end up with 30-40% pacing; with the special algoritm it's down to less than 5%.

Hope this helps.
Best wishes
Inga

maybe

by Tracey_E - 2011-11-09 06:11:20

I think your dr is overly negative and worrying you needlessly. It's possible to develop it eventually but I understood it to be primarily from unnecessary pacing. If you are in block all the time, as I am, the pacing isn't unnecessary. And in my case, the alternative is either no quality of life or no life, so it is what it is. It's simply a risk, it's not a guarantee. I've been paced almost 20 years now, got my first one in 1993, and my EF is as good as it was the day I got it. We have members who have been paced 30 and even 40 years and they're still fine, too.

I'm with TraceyE.

by Gellia3 - 2011-11-09 08:11:29

I second what the others have said and I'm one of those that has continuously RV paced for over 36 years.
Got my first PM in 1975 for CCHB and have been 100% right pacing since.

Not everyone will develop CHF. I don't believe they know why one gets it and another doesn't, but just right pacing hasn't bothered me a bit. My EF is still at the same 55% it has always been.

Good luck, and maybe your dr should come here and tell us why some of us HASN'T had the problem if he's so sure you will.

Best to you,
Gellia

RV Pacing & CHF

by SMITTY - 2011-11-09 10:11:13

Hello DJhan,

I think your doctor's bedside manner sucks. Yes RV pacing can lead to CHF, but CHF is not a death sentence. What he should have been doing is telling you how limited your days would be at age 43 without the benefit of that RV pacing.

I was diagnosed with CHF in the '80s at about age 57 and I'm now 82 and I'm still here. I watch my ejection fraction (although there is nothing I can do about it) which is now in the mid-40s. However, other parts of my body restrict my activity in various ways much more than the CHF.

Looks to me like your Dr was trying to impress you with his knowledge about the side effects from having a PM. Anyway, if your RV pacing does cause you (not everyone suffers this side effect) to have CHF it is a long ways down the road and who knows what medical miracle await us each year.

Good luck,

Smitty

Two things...

by golden_snitch - 2011-11-10 03:11:08

First thing: If the doctors don't tell you that right ventricular pacing can lead to heart failure, and you would go into CHF, you'd be mad at them. Now that a doctor informs his patient, you say that he's being negative and has bad bedside manners etc. I do agree that they way he told djahn about it probably not the best way, but at least he informed him. I know that there are many here who did not get that piece of information from their doctors, but learned about the possible adverse effects of right ventricular pacing on this board.

Second comment is on the unnecessary pacing: Well, the thing is that it's even worse, if people who do NOT need to be paced in the ventricles much, develop CHF due to too much pacing. In patients with a third degree, permanent heart block there simply is no alternative to 100% pacing. When I hear my EP talking about right ventricular pacing, he usually refers to the unneccessary RV pacing. That's because in many patients there is an alternative to high pacing percentages. There are many here who were diagnosed because they passed out from time to time. Most of them do or did not have a permanent heart block, but only occasionally, so they passed out. But if you ask them for their pacing percentage today, they tell you figures around 30%-60% or even more. And, no, this is in many cases not because the pacing is really needed, but rather because the pacer is badly programmed. Unneccessary pacing is a real problem. There are lots of cardios out there who do not optimize AV-delays etc. I have heard some say it takes so much time to go through all the settings, they prefer automatic settings; others say there are so many pacer models out there, that they don't know how to optimize settings in every model. Like I said, I have intermittent heart block, and if they'd just put me into a DDD pacer mode with a normal AV-delay, I end up with 30%-40% ventricular pacing. With the mode to reduce ventricular pacing, I'm down to less than 5%.

Best wishes
Inga

CHF

by pete - 2011-11-10 07:11:09

Look whats wrong with me-
Had CHF so many times I cannot tell you how many !!!
Have been completely written off by the doctors as impossible to save.
Have idiopathic thrombocytopenia
Have cardiomyopathy
Have leaking mitral valve
Have permanent AF
Have AV node ablation
Have biventricular pacemaker.
Yet here I still am working away as if there was nothing wrong. Tell yourself you are made of the right stuff.
Doctors are so often wrong, take it with a pinch of salt.
However I do agree you might be better of with both ventricles being paced to keep them in synchrony.

Good thought Tracey

by ElectricFrank - 2011-11-10 12:11:35

Your comment about unnecessary pacing go me thinking. If a pacer pulse arrives just before a natural pace it could start a contraction from 2 places on the heart wall. Maybe that's what is happening with some of those heavy non PVC beats we sometimes feel.

I've been noticing on my self monitored ECG that my PVC's have kept getting later until sometimes they arrive very close to where the pacer pulse would normally arrive. The adapta seems to catch it and inhibit the pulse if the ventricle has already started a cycle, but once in a while the two are so close they both fire. It makes for a weird wave.

If this thing was happening on a regular basis I could see where it wouldn't be the best for the heart muscle. Kind of like having a car engine ping with bad gas or stepping on it to hard.

frank

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