Ventricle Only Pacing?

Hey all,

I have my 1 year check-up coming up in a few weeks, so I've been doing som reading/research so I can be prepared with questions for my doctor, and one thing I came across is that pacing of the ventricles can weaken the heart and lead to heart failure.

This concerns me a lot because I'm only 32 years old, so I'm obviously going to have a PM for a very long time, and last time I was at the doctor (which was my 8 week follow up after implant) they had told me that my ventricles were being paced 39% of the time, and only had 2% atrial pacing.

From my limited understanding of pacing, this sounds very bad for my long term heart health. The doctor didn't mention ANYTHING about this, so am I missing something? And if I am at risk, is there anything I can do?

FYI I had my pacemaker put in due to complete heart block with HR in the 30s. Never passed out but did feel dizzy/light headed often. They think the block was caused by an ablation I had years earlier to correct WPW. Implant was October 2016.

Thanks!


4 Comments

Ventricular Pacing Consequences

by Hoosier Daddy - 2017-11-30 23:00:41

There are well known side effects of chronic pacing of the right ventricle, most notably the possible development of atrial fibrillation. This can happen because most pacers drive the RV from a lead anchored into the apex (pointy side) of the RV, but a normal, healthy heart fires its electrical system in the opposite direction, beginning at the high septal wall and travelling downwards to end towards the apex.

Google "Pacing Clin Electrophysiol. 2006; 29(3):298-315, 

or N Engl J Med 2007; 357:1000-1008.

One of the hottest topics in pacemaking is "His bundle pacing" (HBP, not to be confused with "high blood pressure"). This is where the RV lead is anchored into the high septal wall near the bundle of His in order to attempt to fire the ventricles electrically in a more physiolgical manner. 

There is also research into pacemaker leads anchored into the septal wall generally, not specifically into the His bundle.

Regarding an already indwelling dual lead system, some people could theoretically reduce their RV pacing percentage with AAI/AAIR programming, but whether this program is optimal depends on whether a patient has sinus node disease, AV node disease, pacing thresholds in the RA, etc. Unfortunately, if one's diagnosis is third degree ("complete") heart block, AAI/AAIR is inappropriate because neither a natural atrial beat or a paced atrial beat can travel downward and cause the ventricles to fire. 

 

 

 

Hi

by Bionic Beat - 2017-11-30 23:49:49

The great news is that you DO have a pacemaker and should be okay for quite some time.

We can't do much when our bodies 'let us down' or something like complete heart block happens but we are very lucky to live in a time when they can slap a pacemaker in to keep us ticking over.

I think you should start writing down any/all questions you have, for your upcoming appoinrment as these are important and 'deep' questions that are best answered by your doctor as it pertains to only YOU.

You might want to ask your doctor if Cardiac Rehab is something to consider and if its available in your area/do you have coverage etc.   I found it to be most helpful after a period of heart failure corrected by a new dual lead pacemaker.

Im paced 100% of the time, have been for nearly a decade and I dont really worry too much about it.  I have had a couple of episodes of heart failure, both times they've been able to 'do' something to correct it and my EF has improved significantly.   My heart isnt as good as it was before things went wonky but Im still here and enjoying life.  THATs what matters to me!!

 

Best Wishes,

 

Bionic Beat

 

 

 

Stop! right where you are...

by donr - 2017-12-02 00:15:50

...& ask yourself one very simple question"...What alternatives are there for me with a complete blockage?????"  "How long would I live with no PM?"  "How long will I live with the RV only pacing?"  "Which is longer?"  "What will the quality of life be in either case?"

I'm waiting for Tracey to weigh in on this one.  She can speak first person in answering all those questions.

Donr 

pacing

by Tracey_E - 2017-12-10 09:12:45

Sorry I'm late to the party! Unnecessary pacing is bad. If we have 3rd degree av block, it's not optional if we want any quality of life so everything is relative. For us, not pacing would be a lot harder on the heart. As Hoosier Daddy said, they've changed how they place leads over the years so it's easier on the heart. I've been paced 100% ventricle since 1994, got my first when I was 27. My EF is still the same as it ever was, I'm healthy and active. Check the photos I've posted, I make it my mission to counter all the post-op pictures with pictures of activity and loving life. Because I do, there is nothing I want to do that I cannot and the pacer doesn't hold me back at all.

I switched to an adult congenital practice last year because now that I'm past 50 I wanted a doctor who has other patients like me, who could tell me first hand what my expectations should be as I get older. He said that if someone goes 5 years of pacing and EF doesn't drop, then he rarely sees it become an issue later. This was a huge relief to me, in the back of my mind I've always wondered if the day would come that my heart stopped responding so well to pacing and I'd lose my ability to be active. I do Crossfit daily and the new ep and I spent a while debating whether the best skiing is CO or UT. He predicts my joints will give out before my heart does. 

The best thing we can do for ourselves is be active and eat well. The electrical problems we have and the pacing is out of our control. Be eating well we prevent clogged arteries, by staying active we keep the heart muscle strong. I also take magnesium and omega3 every day. No one ever told me to, just seems common sense to do what I can to support overall heart health. Right now my heart is basically fixed, I don't want to complicate things with conditions that can be prevented by lifestyle choice.

You know you're wired when...

You fondly named your implanted buddy.

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