Mitral valve

Hi everyone,

Newbie here first post so please treat me gently. 

At a recent pacemaker check I was concerned that my ventricular pacing had increased and the consultant mentioned that there could be a link between this and mild mitral valve regurgitation which was found on my echo.  The technicians then made some changes to my settings that have reduced the ventricular pacing.  I asked what they did and they mentioned some algorithm to extend the AV delay?

I know I should have asked this whilst at the hospital, but I am now wondering if the reduction in ventricular pacing will improve the mitral valve regurgitation?


Watchful waiting

by Gemita - 2023-11-12 09:44:20

MrSquirrel, first of all, a big welcome.  Depending on the reason for our pacemaker, if we need to be paced in the right ventricle, even if that need is as high as 100%, then it would not be unusual or unnecessary.  An increase/decrease in pacing can occur for a number of reasons like settings changes, any medication/dosage we are on, and any changes to our heart/health condition and things like this. 

As to whether any reduction in ventricular pacing will improve your mild mitral valve regurgitation, only time will tell.  But mild regurgitation of a valve is something that many of us have, with or without a pacemaker and this condition may never progress.  I have mild regurgitation of several valves and have had this condition, without change, for many years.  My cardiologist just watches.

I hope the changes to your AV delay will not adversely affect your quality of life or pacing experience. I expect they have lengthened your AV Delay to try to reduce the time you spend pacing in your right ventricle?  What is important though is how we feel and if we feel well with our degree of pacing, then that usually suggests that it is doing no harm.  Some members in an attempt to minimise ventricular pacing, have often caused other problems.

What is important is that your doctors keep a close eye on you and that you get regular monitoring of your heart condition with regular echocardiograms.  On your part, it is important that you report any new, concerning symptoms like breathlessness, chest pain, palpitations, dizzy spells or other unusual symptoms.  

I hope you do very well with your pacemaker and that you will be reassured that your mild mitral regurgitation may never progress


by MrSquirrel - 2023-11-12 13:20:51

Hi Gemita,

Thankyou for your welcome and response. Did your cardiologist think that your valve problems originated from being paced?

No, I had mild leaky valves before pacemaker

by Gemita - 2023-11-12 14:05:03

MrSquirrel, no I had valve problems well before my pacemaker was implanted (first diagnosed in 2009 and pacemaker in 2018 for tachycardia/bradycardia syndrome).  I was quite worried at first since there were three leaky valves, but they were not concerned at all and in fact the Cardiologist was of the opinion that my mild, leaky valves would probably never progress.  And he was right.   If they get worse - moderate leakage, then that would be more concerning.  I have rhythm disturbances too.  I see you have had a mild heart attack. I am so sorry tohear about this.

Just keep a close eye on your symptoms, but if you feel well, I would feel reassured that all is well with your heart and with pacing

Seems a Reasonable Step in the Right Direction

by DoingMyBest - 2023-11-12 21:48:39

Yes, my understanding is that ventricular pacing can cause cardiomyopathy which includes various reshaping of heart chambers, and this in turn can contribute to mitral valve regurgitation. So yes, I think your consultant was correct - there may be a link. Though, you'd probably want more testing (multiple echocardiograms over time) to have a better picture.

Extending your AV delay gives your intrinsic conduction a better chance to pace the ventricles on its own before the pacemaker needs to intervene. If your AV node and intrinsic conduction are up to the task, then yes, this will reduce the amount of ventricular pacing.

Will this improve your mitral valve regurgitation? Perhaps. It seems a step in the right direction. Also, Gemita is correct that MR is common but often is too slight to be a problem and may never progress to being a problem.

Good luck. I hope your new settings work out well for you.

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