Wenckebach

A Bit Confusing

by NiceNiecey - 2019-02-05 03:01:23

Hello Again Jereems!

Some of what you're relaying doesn't make sense to me. HOWEVER, Please don't confuse my inabililty to understand your questions with what you said. I'm not an expert AT ALL. But I do have Mobitz Type 2 heart block that quickly became Complete Heart Block (aka Type 3) during the first year of pacing. 

What I do know is that Heart Block Type I does not really call for a pacemaker. Type 2 may and Type 3 must. The realization that 'it's time' for a PM can be sudden or gradual as one becomes symptomatic. For me, it was sudden. Looking back, I see things much differently but I'm not looking back because I'm not headed that way.

And don't worry about how much you pace. That is a frequent, if mild, obsession for the newbies. It certainly was with me! But all the wondering is now over because I'm paced 100% in both chambers. Wasn't that easy??

I hope that helped a little.

Niecey

unpacking what they said

by Tracey_E - 2019-02-05 09:49:53

I don't know what av wenckeback less than 130 bpm means but! here are a few of the things I do know

- av block usually is an issue between the sa and av nodes. Most of us have normal sa nodes so when our rate dips it's not because the atria isn't going fast enough, it's because the signal isn't getting to the ventricles. 

- 2nd degree means you may or may not need paced because you are not in block all of the time (that's 3rd degree). If you aren't getting dangerously low, if your rate goes up enough on exertion that you can do what you want to do, if you aren't overly tired or dizzy, then you may be able to keep an eye on it for now.

- what do they hope to learn from the ep study? You already know what kind of block you have. 

- as Niecey said, don't worry about how much you pace. I have 3rd degree which means I pace every beat. I got my first pacer in 1994 and have paced every beat since. I finished my first half marathon last month. My heart function (EF) is still excellent and there's nothing I want to do that I cannot. Don't get too caught up in the numbers. 

- doctors do not all agree that 3 lead pacing is the best choice for av block. My doctor disagrees with it, said there is no evidence that it will decrease the chances of heart failure down the road. Yes, a small percentage who are paced for av block will end up with heart failure, and some of them will be helped by having the 3rd lead, however my doctor said he doesn't expect it to happen me and if it does we'll cross that bridge when we get to it. Others will vehemently disagree with this and think 3 lead is your best bet to prevent heart failure down the road.

2 lead was the only pacing available to me when I was first paced.I've been offered the upgrade but turned it down. I changed doctors and asked my new ep what he thinks, he was against it so I'm comfortable staying with my 2 lead. He specializes in congenital so most of his patients are paced all of their lives so I trust him to know more thanthe average cardiologist about long term pacing. If I was starting this road now, I would look in to HIS bundle pacing rather than 3 lead pacing. Much less invasive and easier on the heart, effectively does the same thing but it's done by lead placement, not a lead in each ventricle. 

I added some info in Bio

by Jereems - 2019-02-05 10:24:33

Bio added info may help explain what is not clear. 

Thanks Tracey and Niecey

by Jereems - 2019-02-05 10:36:48

They seem to have determined Second degeee type 1. They want EP Study to investigate Wenckebach bpm as it will help decide whether pace both ventricles. (I think). WB bpm less than 130 seems would steer them to CRT, that is, both ventricles  

It is LBBB so pacing HIS does not target the problem. HIS probably fine already. 

HIS pacing

by Tracey_E - 2019-02-05 10:46:41

HIS pacing is for LBBB. It's not about fixing the bundle of HIS, it's how the lead is placed. Check this out

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020230/

Thank you for that url.

by Jereems - 2019-02-05 13:46:53

It is fascinating, this whole area of heart disease and intervention. Seems to provide an alternative to traditional CRT. Yes, footnote 20 or 26?? reports a double-blind study 2014 also another reference to one about 6 yrs earlier. I would imagine the Doc would likely await further evidence. 

I suspect, in view of the multiplication of tests, that they are not entirely clear about extent and reversibility of heart muscle damage. Subendocardial damage lower to mid left ventricular wall as well as exact status of septum in lower left ventricle. How responsive these may be to pacing? 

It is non-ischemic damage, arising from physical injury? Auto-immune disease? Some infection. 

There is wall thickening and I think septal thickening—suggestive of auto-immune activity??? I have to trust my Doctor to do the figuring-out. And I do!