Question to ask

I have had a pacemaker for about 2yr 4m. Reason they put it in was heart rate of 30 when exercising. Last 8 months a drop in my ability to exercise. A hill of  2/10 of a mile that I could walk to the top of without stopping,12 months ago, I must now stop and rest two or three times. So my cardiologist sent me for a nuclear medicine stress test. Preliminary results no blockage, but a drop in my ejection fraction to 36% from about 50%,when the pacemaker was put in. I am very worried about that drop. My cardiologist is sending me for a echocardiogram next week to get more information, I guess. Been researching online for reasons, don't like most of the answers. One easy fix was an adjustment to my pacemaker.  Would this bring the EF up enough? Can my cardiologist do this or should I ask to see an electrophysiologist. Some of the things I find frightening are, congestive heart failure, pacemaker-induced cardiomyopathy, or one of the many other types of cardiomyopathy. I am sure I will be meeting with my cardiologist after the echo. Any thoughts about what to ask about, or insist on. Would be very much appreciated. I am trying to stay positive and informed.

3 Comments

Heart failure medications can help

by Paced2017 - 2018-05-06 06:16:31

I understand your worry about your drop in exercise tolerance and ejection fraction (EF). Do you know how much you are being paced in the right ventricle? Pacemaker-induced cardiomyopathy(heart failure) is more common if ventricular pacing occurs more than 40% of the time.

Medicatons such as ACE inhibitors and certain specific beta blockers can help to raise your ejection fraction and improve symptoms of heart failure. I think this might be the first thing your cardiologist suggests. If this doesn't help an aldosterone antagonist may also be added. 

Your doctor may also discuss upgrading your pacemaker to a CRT. Another option called his bundle pacing which produces a more natural synchronised contraction of the ventricles is also worth asking about.This may improve your ejection fraction or at least stalbilise it, and avoid the need for an expensive CRT device.

 

Pacing

by tommiker70 - 2018-05-06 07:49:21

I have been up early resherching. I am excitedly looking into, His-bundle pacing (HBP). If I have right-ventricular pacing-induced cardiomyopathy. It might require another surgery but I might give it a try if it will get me up the hill for a little while longer.

I will bring it up with my cardioligest on my next visit.

MY two cents

by Gotrhythm - 2018-05-06 14:59:17

I think HBP is well worth looking into. Do not expect the aveage cardiologist to be a good source of information about it, however. Doctors in private practice tend to be medically conservative. They are suspicious of recommending what they have no personal experience with--rightfully so.

But even among EPs, implanting the HBP is a speciality. It takes skill that not every EP has. Your time, and money, would be better spent consulting with someone who is experienced with HBP, even if you have to travel. Just my two cents.

But you also wondered if you should consult an EP. That would be a good idea. An EP has the specialized knowledge to know if and how your pacemaker settings can be tweaked to possibly get a better result--which a cardiologist might not have.

All of this is just my opnion. I claim no special knowlege, but I have had a lot of experience consulting with doctors about a condition that was outside their level of expertise. I wasted two years.

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Member Quotes

The pacer systems are really very reliable. The main problem is the incompetent programming of them. If yours is working well for you, get on with life and enjoy it. You probably are more at risk of problems with a valve job than the pacer.