Biventricular PM..

I am 40 years old and had OHS 4 months ago to implant an On-X mechanical aortic heart valve, repair the mitral valve with a ring, and a LIMA bypass (not required now, but while they had me open..)

I have been recovering well, and exercise daily, aerobic and weights. My heart and LV has shrunk back to normal size, but the EF remains too low at ~40%, and is not likely to improve any further by itself.

Since I have a left bundle branch block, my cardiologist has suggested a biventricular PM, since he believes it can really help the pumping efficiency and even increase the EF. I don't really have any symptoms of too low EF, but I have quite a ways to catch to where I was a year before my surgery, and I am hopeful this will get me closer to the aerobic capacity I had for bicycling, hiking, etc. before the sudden onset of valve problem symptoms.

I will have a radionuclide ventriculogram today to determine the accurate EF, since the echocardiogram calculated one is just an estimate. If the EF is lower than 35%, my cardio may suggest a combined ICD/BiV device, but I am less enthusiastic about this option, for a few reasons:
- I am pretty skinny. The extra size of the ICD unit will be noticeable.
- A combined device has a shorter lifetime, possibly only 1/2..
- I really (want to) believe my EF is > 35%, or if borderline, it will increase with a BiV device.
- I believe I never had an a-fib episode.
- Risk of accidental shocks during high intensity exercise.

Is there anyone else here with a biventricular PM, and what is your experience with its ability to increase your aerobic capacity?

5 Comments

Helped

by mike thurston - 2009-12-03 03:12:35

I had a EF of 15% and was in permanent a-fib. After a failed mini-maze and lots of issues I received a total ablation and the Bi-ventricular PM setup. EF went to 45% and was recently about the same after 2.5 years. Exercise a lot although I get winded easily going uphill. Had no choice but to go this route. Happy with outcome but wish I did not have to be in this situation but it is what it is and could be a lot worse. Being PM dependent is scary but if you will not be totally dependent and it got you to where you want to be as far as athletic performance is concerned than it might be the way to go. On the other hand if you are not at risk of SCD and are functioning relatively o.k. but not up to competitive level it might be best to accept your limitations and not have all the hardware and asscociated risks. Tough choices only you can make with the advice of your Doctors. Best wishes.
Mike

Bivent. PM

by J.B. - 2009-12-03 07:12:43

I'm sure Patch knows more about this subject than I so I'm not trying to contradict him. However, it is my understanding that being athletic may slow the heart rate, and will probably increase the EF. That being caused by an athletes heart muscle of being stronger it will pump more blood with each stoke.

You say your Ef is about 49%. Whiles it is lower than desired it is not in reality that low. A normal EF is considered to be anywhere from 50% to 70% (according to my Cardio) so if you call 60% as average or normal your 40% is about 67% of that number.

I am in total agreement with Patch about it being too soon after major heart surgery to be making drastic changes. The heart seems to take a dim view of being diddled with and sometimes takes a while to return to what is normal.

CRT_D (ICD w Bivent I think)

by mrag - 2009-12-03 11:12:46

I had a triple bypass about 3 1/2 years ago and got a single lead ICD at (almost) the same time. My EF is currently 25 although I think I feel pretty good. My cardiologist is pushing to replace my current ICD with the CRT_D. The old one has fired appropriately 8 times and they say the battery should make it to this summer-a good time to "upgrade.' I was told 30% of the people have a "big" improvement, 30% some improvement and 30% have no change. I've no clue what happens to the other 10%.

I agree with the others-it is still early. I'd have a "heart to heart" talk about what it would mean to wait a bit longer. As to a PM vs. ICD, percentage wise, very few people actually get inappropriate OR appropriate shocks although psychologically the ICD is IMHO, a real burden to have. Personally I think if they give you an ICD and if fires, you should get a free case of Zanax.

BIVENT ???

by pete - 2009-12-04 02:12:03

They are fantastic devices when fitted to the right patients. Most patients enjoy a tremendous improvement in their heart function particularly if an AV node ablation is given as well. This is when biventricular come into their own. I think they are a bit of a waste without the combination as they cant perform properly if they have to compete with existing ventricular pulses. The idea of another ablation probably frightens you but it is the quikest and easiest and least risky to perform of the heart ablation proceedures. I went from not being able to get out of bed to climbing a mountain 16 weeks later. Here in the UK they dont normally fit that type of pacemaker unless your EF is below 35, but I suspect that is to keep the costs of running the NHS down. Cheers Peter

Thanks

by realkarl - 2009-12-04 11:12:24

Thanks for everyone's feedback. My current estimated EF is 40% (not 49), and closer to the 35% threshold than a normal EF at 55%. I will probably hold off a little longer, but I seem to have reached a point where I am not improving much, even though exercising daily. And exercise does not improve EF, sadly. It's stuck at 40% since 3 weeks after surgery. And when I have not even reached a point where I am in as good shape as right before surgery, and far far away from a year before surgery, I will weigh the potential advantage vs risk and inconvenience carefully. My cardiologist's specialty is cardiac electrophysiology and he says my profile with the LBBB is a very good candidate for seeing substantial improvement from a biventricular PM.I would really like to be able to enjoy bicycling and other physical activities as much as before.

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