Dual Chamber P

I’m a 57 yr old male and my original PM setup was a lead in coronary sinus and one in rt atrium back in April of 2015. Coronary sinus lead lost capture and EP couldn’t remove lead so he placed a new one in RV to mid septum back in May of this year (new PM as well).  My ejection fraction a few months later is 42% with severe LV dilation according to echocardiogram last week. Never had any LV dilation from previous echos.

Anybody have issues with pacemaker induced cardiomyopathy? 

3 Comments

I don't have cardiomyopathy

by AgentX86 - 2018-09-08 00:31:21

I assume that your two leads are in the right atrium and right ventricle. The sinus node is in the right atrium so it makes no sense to have a lead in the right atrium and one in the sinus node. This is a fairly common setup but it does have a problem with pacemaker induced cardiomyopathy. It's not at all unusual.

This is caused by assymetrical pumping of the heart because of the delay between the left and right ventricles, due to the single ventricle lead in the right ventricle.  Think of your heart as a water ballon.  If you squeezed the right side of the balloon with one hand, then a half second later squeezed the left side, you'd notice that the balloon will bulge out the left side before you squeeze it.  This causes the heart to "remodel" (change shape) and you have cardiomyopathy.  To counter this, a third lead is added to the left ventricle and both ventricular leads are triggered together.  Both sides pump together, which is a more normal heartbeat. 

This setup is known as a CRT (Cardiac Resynchronization Therapy) pacemaker.  They come in two varieties, CRT-P, which is just a pacemaker and CRT-D, which is also a defibrillator.

As I mentioned above, I don't have cardiomyopathy but my EP prescribed a CRT-P pacemaker for me, though I don't have the atrial lead.  I have an AV ablation and the atria and ventricles are desynchronized, intentionally.  The ventricles beat on their own, and the atria are essentially useless.  My EP specified the CRT pacemaker to avoid pacemaker indued cardiomyopathy. 

The good news is that Pacemaker mediated cardiomyopathy is otten reversable, using a Cardiac Resynchronization Therapy.pacemaker.

PM Induced Cardiomyopathy??

by gaman - 2018-09-08 09:39:18

I have a lead in RA and one in RV.  Had to get pacemaker as I had my tricuspid heart valve repaired back in 2014. I was lucky that didn’t damage my heart muscle and put me in heart failure as no Dr could seem to diagnose me and the severe regurgitation went on for a long time.

Sounds like numerous PM recipients experience some form of PM induced cardiomyopathy.  I’ve read that most PM or arrythmia induced cardiomyopathies can be partially or fully reversible. I’m currently asymtomatic with good exercise tolerance. Will see EP Tues as a follow-up to latest echocardiogram to map out tratment plan going forward.

 

PM induced cardiomyopathy

by AgentX86 - 2018-09-08 13:49:38

Yes, obviously it's best to treat cardiomyopathy as soon as possible, though the treatment is likely a new pacemaker and at least one new lead.

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