pacing ???

Still not sure how "Gizmo" works. Again, prior to implantation, I had very few symptoms that most ppl have. Never fainted, no chest pain, only S.O.B when doing hills. But I did have bradycardia (50-60 BPM) and skipping beats. Oh and total left bundle branch block. My EP implanted the 3 wire Medtronic ICD. My heart rate now during resting is around 70 in the afternoon and low 80's at night. But I still have a very irregular beat... approx 5-7 skips every minute. So exactly what is the 3rd wire doing? And when does Gizmo pace??? Actually, I dont feel much different, except that I did a hill yesterday and was actually able to do it with no problems. I'm still concerned about the skipping. Doesn't an ICD correct that? I feel SO stupid asking these questions, but the Dr. never really told me much. In & out...... just another routine surgery for him.

8 Comments

thanx

by irisheyes317 - 2010-02-02 01:02:38

OK, so if a lead is dislodged, that means another surgery, right? I will totally freak out! Let's hope it just settings that need adjusted. I'll let you all know how it goes tomorow. (especially to you wenditt) As far as the ICD, the EP talked to me about a PM/Defib. then brought up the subjest of the 3 lead, which he said was a fairly new concept that shows promising results and made the heart work better. He asked if I'd consider it and being scared & thinking I was going to suddenly drop dead from heart failure, my hubby & I said OK. But he made us feel as if it's what he highly recommended. I'd hate to find out I was used to teach a med student how to implant the leads or that the EP was in Medtronic's pocket! 'Cause this thing is big & heavy! LOL

leads

by Tracey_E - 2010-02-02 01:02:51

They can tell very easily if a lead is dislodged. It's possible that's what your feeling, but it's more likely the settings just need adjusted. It can take a few tries to get it just right, it's a bit of trial and error and best guesses.

Three leads are often used to increase EF. Sychronizing your ventricles helps how efficiently your heart beats.

I would ask why they gave you the ICD. They're an excellent precaution, but nothing you've mentioned explains why you would need it. Not to say you don't need it, just saying why you have it is not clear :o)

leads

by Tracey_E - 2010-02-02 02:02:14

If a lead is dislodged, yes it's another surgery but it's MUCH easier than what you've already been through!!! All your hardware stays the same, they'd just move the lead that's not in place. But cross that bridge when you get to it, my money's on something simple like the settings needing adjusted.

If your EF is low, then a 3-lead device was a good choice! Yes they're fairly new but results can be amazing. And it's better to get it now than get a 2 lead but upgrade in a year or two if your EF drops more. Your dr was thinking ahead and doing everything he could to get you feeling better now.

Not all 3 lead devices have the defibrillator. It's definitely quite a bit larger than just a pm. Just because I'm curious about why they gave you one doesn't mean you don't need it! I'm sure your dr had his reasons. ICD's save lives. Some people have them for years and they never fire, but it only takes once to save your life. If there's even a small chance you'll need it, it's good that you have it.

to ICD or not

by realkarl - 2010-02-02 03:02:57

I received a 3-lead (CRT-P) device 3 weeks ago (no ICD). My cardio/EP ordered a radionuclide ventriculogram before the procedure to check if my accurate EF was below 35%. If it had been (it was 43%), they would have considered a CRT-D device instead, that is a 3-lead + ICD device. The reason appears to be, from what I have read, that with EF < 35%, chances of a fibrillation episode requiring an ICD are somewhat higher.

It seems a majority of patients receiving a 3-lead (bivent) device also gets the ICD, probably because one of the criteria for getting one, is having EF < 35% ...

I got mine because of a LBBB and reduced EF, but no sinus node or other beat related problems. So my heart is determining the pace, just like before, which is why there is no immediate effect for me, except a healthier synchronized heartbeat, and hopefully increased EF over time.

There are certain downsides to an added ICD: size, battery life, accidental firings (rare), but as mentioned, the major upside is that it is there to save your life, if needed!!

Karl.

Phwwwww!!!!

by irisheyes317 - 2010-02-02 04:02:57

I was working myself up into a tizzy about "gizzy" LMAO those last several answers really put my mind at ease. I'm usually not one to over react to things or freak out. But this whole process, from the initial call from my Cardiologist, till now has done me in. I see where depression is common among us, so I'm going to have to just settle down & realize that better now than later. On a brighter note, I extended my daily walk today to include a rather large hill. I had just a little difficulty toward the top, (then realizing that I'm not in the greatest of shape)but I did it! Prior to Gizmo, I wouldnt have made 1/4 of that hill. YAY Thank you very much!!!!

skips

by Tracey_E - 2010-02-02 11:02:44

Sometimes a little beat will feel like a skipped beat. Tell them what time it happens so they can check the report, but you should not be skipping now.

A lot is going on with your Gizmo. It will always watch your heart. If it's set for a minimum of 60 bpm (using that at random because the math is easiest to explain), that means the first lead in your atria will make sure your heart beats once a second. It's set at beats per minute but actually works in beats per second. If it goes a second and doesn't beat, the pm will generate a beat.

The second lead is in your ventricle. It watches every time your atria beats. If the ventricle doesn't beat immediately after, it generates a ventricular beat.

The third lead is in your other ventricle and makes sure your ventricles are synchronized. This doesn't really affect how fast your heart beats but how efficiently it beats.

The ICD part is a defibrillator, it's there to jump start you if your heart stops or stop ventricular fibrillation.

A 3 lead ICD seems like overkill for bradycardia and skipped beats! Was your ejection fraction low or are you at risk for v-tach?

Skipping

by wenditt - 2010-02-02 12:02:06

My heart skips every third beat. I'm told that's just the way it is. If you get any answers, I would love to hear them!

response to TraceyE

by irisheyes317 - 2010-02-02 12:02:35

Thanks for explaining. My 1st follow up is tomorrow so Im sure they'll get to the bottom of this. Im so afraid my leads arent in place. These skips are definately skips and it feels exactly like it did prior to surgery. My EF was between 30-33. 6 yrs ago, it was 40 so the cardiologist said it was getting worse and I should consider the PM/Defib. (after having a cath, which showed no blockages or valve damage). The EP came in after the cath to briefly explain the procedure and seemed to be "pushing" the 3 leads. He said it would synchronize the other leads to work better. He also said it would be threaded thru a vein/artery running around the outside of my heart to help the squeezing. Never once, with either Dr. did I hear v-tach mentioned. Only some arrhythmias on occasion and of course bradycardia and a lower than normal EF. Thank you again.

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