Hi, I am on a waiting list for a biventricular pacemaker and have opted to have the ICD as I was given that choice. Hopefully this will be done before Xmas.

My question is regarding the medication I am on, I am diagnosed with Dilated cardiomyopathy with a left bundle branch defect. I have been on Entresto, Dapagliflozin and Eplerenone for 18 months now. The Entresto dosage has just been upped to the next strength. What do these medications actually do for my heart? I was told that I am on them for life even after the pacemaker is fitted!

I guess I shold have asked but when I was first put on them it was all a bit of a shock that I had a problem as I have absolutley no symptoms and still haven't! It was picked up due to an ECG I had for a completely unrelated pre opp assessment. I just accepted the meds and started taking without asking too much!




by Tracey_E - 2023-10-05 12:23:19

Pacing will fix the block. When the atria beats, it will make sure the ventricles stay in sync. 

Have you had an echo to see what your ejection fraction (EF) is? CRT is generally used to help that. It paces both ventricles and forces them to stay in sync, which can help EF.

If your EF is very low the heart is at risk of stopping so they recommend ICD. It's odd they'd let you choose, usually they recommend one or the other. Maybe you're borderline?

Entrestro relaxes the blood vessels which reduces stress on the heart. 

I've never heard of dapagliflozin. This was on

Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. This class of drug uses the kidneys to help control your glucose (blood sugar) levels. It works by increasing the amount of glucose removed from the body when you urinate. It also reduces the amount of effort your heart has to put in to pumping blood around your body.

The last one reduces blood pressure. All of these work together to reduce the stress on the heart so it doesn't have to work as hard. 

I'm sorry you have to wait. How frustrating. 


by hippy766 - 2023-10-05 12:34:42

Thanks for the info, the Dapagliflozin is primarily a diabetes drug but apparently they found it was good for the heart too.

As for the EF I don't know the answer to that although I have had two echo's and told my left ventricle is at 20%.

The ICD was discussed with the consultant and I was told that I didn't need one at present but was given the option to have one if I wanted. After having a thourough discussion with the nurses of the pros and cons I decided to have it! My father and both grandfathers died young with heart failure so I feel that anything that can keep me alive in the future might as well just chuck it in!



by Tracey_E - 2023-10-05 12:39:51

If your EF is 20 and your family history, I would totally choose the ICD! If it's 20, you're well into the range where they recommend it. It's amazing you don't have symptoms!

medication for heart failure

by Gemita - 2023-10-05 13:53:25

Hello Hippy, yes with an ejection fraction of 20% you need all the help you can get.  Mind you my sister had an ejection fraction of 16% (we also live in the UK) and she was only managed on medication, so meds alone can really help too.  Her ejection fraction is now around 43% (within 6 months) so she is out of danger.

She was given Dapagliflozin, although she is now taking Jardiance, both are diabetic meds but are also used as the new magic med to support heart failure patients.  The only thing to watch out for is that it may make you more vulnerable to urinary tract infections because your urine can become concentrated and full of glucose due to the action of this diabetic medication.  Taking Dapagliflozin makes you urinate extra glucose and it can help bacteria to flourish in the urinary tract.  Regular antibiotic treatment may become necessary unfortunately unless you keep well hydrated with plenty of clear fluids (water) if safe to do so?   Speak to your cardiologist. 

My sister is also taking a cocktail of other meds including Entresto and Eplerenone, so clearly all regular heart failure meds recommended by heart failure teams.  I am sure you are in good hands.

I wish you well and hope that between your meds and pacemaker/ICD support in the future, you will recover well.  They will probably want your ejection fraction to recover a little before your procedure, perhaps that is why you are having to wait?  

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Pacemakers are very reliable devices.