CRT-P

Looks like I may have pacemaker induced cardiomyopathy. EP couldn't definitively tell me that's what is causing cardiomyopathy (40% EF) but I've been ventricle pacing at over 90% for a few years and I have a wide QRS (>150ms) so ventricles are definitely outta sync.  EP recommends a CRT-P and I'm set to have it placed in less than 2 weeks.  This will be my 3rd PM in 4 years:(

Any thoughts?  What kind of battery life would I get vs a standard dual lead PM? 

Alan

 


7 Comments

pacemaker cardiomyopathy

by Dave H - 2019-02-08 21:55:22

Yeah, I've heard of it - but I've no knowledge of the affliction.  Maybe you can provide some education for the rest of us.

--Dave--

crt-P

by gaman - 2019-02-08 22:06:48

This link from Cleveland Clinic discusses pacemaker induced cardiomyopathy. Believe it has to do with the manner in which the heart is being stimulated with pacemaker vs normal heart conduction. Have no clue why it only happens to a select few.

https://www.google.com/amp/s/consultqd.clevelandclinic.org/pacing-induced-cardiomyopathy-patients-heart-block-normal-ef-know/amp/

alan

CRT-P

by AgentX86 - 2019-02-09 00:27:06

The CRT will almost surely help if the problem is pacemaker-induced cardiomyopathy.   I've had a CRT-P for a year, though only the two ventricle leads.  Accroding to the pacemaker clinic, I should be good for about 8-1/2 years on the battery.

been there done that

by dwelch - 2019-02-12 02:08:19

Supposed to take 15-25 years for any of us with a pacer (well with a dual chamber).  In my case after 30 years of pacing I did switch to a 3 chamber pacer from a two chamber, my EF responded immediately, had gradually declined down into the 30s over time and bounced back into the 40s which is normal for me, on the next echo after the new pacer.  

The doc implied that it was just supposed to stop the decline and not necessarily improve the EF but it did in my case.

The heart normally paces from the middle but the V lead is not in the middle it is in one chamber so the heart is not paced normally, over time this has a negative effect.

Periodically they should be doing an echo and if they see your EF somewhere in the 40s they should hopefully start doing that echo every year rather than every so often.  And keep an eye on it.

Talk about the mental side of having a pacemaker, I got over the whats wrong with me stuff decades ago.  But normaly with this doc the echo is the same day/visit as the checkup, they moved between the implant and the 6 month visit so I didnt get my echo at 6 months to see if the biventrical pacer worked.  I had to wait another 6 months so it was a year of not knowing if it worked, not knowing if this was pacemaker induced or if I was moving onto an ICD next.

I have complete heart block and am essentially paced on the lower chambers most/all of the time.  100% pacing is not a bad thing, depends on your condition.

Dual lead pacers esp for those with high pacing are simply larger.  They still aim for that 10 years plus or minus.  I am on a three lead now biventrical, still expect 10 years plus or minus.  they cant relly predict though we are all a bit different I have a 30 year lead and a 23 year lead and 2 year lead, older and newer scar tissue, etc.  First two were about 7 years next one was closer to 10, we took number four out early to put in the biventrical pacer.

Number 4 was a st jude was supposed to get me more like 13 years, but we didnt get that far on it.

You are definitely a pro at recovery.  I dont yet understand why they are tossing pacers into you at that rate.  You trust this doc?  Until they can find a pacer that is compatible for more than a year you dont need to worry about how many years they last.  short answer I expect 7-10...happy if it is the latter.

My current three chamber is still smaller than my first dual chamber from 30 years ago.  each pacer got smaller to number four which I could barely feel/find in there it was so small, size dominated by the connectors.  but number five being a biventrical is definitely larger than the last one or maybe two.  Probably smaller than an ICD.  If/when they match you up with a device it should be one that gets you into that 7-10 year range, should be sized for your pacing requirements and condition.

checked my printout

by dwelch - 2019-02-12 02:45:28

well I checked one from my few month checkup after I got pacer number five.  both v leads paced at 100% (as expected).  expected life which is generally bogus and in my experience years shorter than reality says 9.5 years.  not one but two v leads 100% expecting a 10 year life.  despite preaching that you should always get your printout, which I always do.  I dont necessarily keep them somewhere I can find when I get home, I dont throw them away, so I dont know what my latest one said about guestimated life expectancy on the battery.

Well that is disturbing  my firmware version is 1.00.00. Oh well...

 

CRT-P

by gaman - 2019-02-12 10:26:58

A little more history about myself. I had heart surgery for severe isolated tricuspid regurgitation back in 11/14. Tricuspid valve was repaired. Original standard dual lead PM installed 4/15 for complete heart block and I had a left ventricle lead placed in coronary sinus vs the standard right ventricle lead placement to avoid tricuspid valve. There was a dip in ejection fraction to low 40's a few months later (8/15) but the next two years EF was in mid to high 50's. Note that my QRS has been wide since tricuspid surgery in 2014.  Echo in 3/18 showed a reduced EF and PM interogation showed the LV lead had lost capture so they cut up the voltage so LV would be stimulated. Unfortunatedly, PM had to be replaced in 5/18 as battery was rapidly draining down due to increased current drain.  During replacement, EP couldn't remove CS lead as it broke off so it was abandoned and he put in a RV lead (std setup) and indicated it was set in center of valve to minimize chance of damage to tricuspid valve.  I've had followup echo's in Sept and Dec of 2018 and both are low 40's with some RV and LV dilation. 

In short, EP can't tell me for sure that I have PM induced cardiomyopathy but both he and another EP at different hospital agree that the dyssyncrony of LV and RF (high QRS) and the fact that ventricle pacing has averaged +90% of the time puts me in a category that would benefit from a CRT-P therapy........how much........God only knows?  I think both EP's are very good but as the old saying goes, 3rd times' (PM) a charm so if this doesn't work, I'm heading back to Cleveland Clinic in Ohio where I had my tricuspid surgery. BTW, the valve has worked fine the last 4 years.

What have you seen EP's do with regards to trying to minimize scar tissue at lead electrodes? Do they have mult-electrode leads that have alternate pacing locations?

Alan

CRP-P size &Cost

by gaman - 2019-02-17 00:16:17

Scheduled for a crp-p install in less than 2 weeks. Dr will replace a dual lead std pacemaker that was just installed back in May last year. It’s a submuscular implant. 

How big is crt vs dual lead pm and would there typ be any issues using the same pocket where current pm is installed?

How much more expensive is crt-p vs std dual lead pm?

alan

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