Pacemaker Replacement
- by Mark_NYC
- 2019-10-23 12:37:42
- General Posting
- 759 views
- 2 comments
Hi: I'm a new member, and have a question I'd like to ask the group. By way of background, I'm a 78 year old male, was diagnosed with AFib in 2013 and had a pacemaker implanted at that time for brachycardia. Subsequently, I had two catheter ablations that were unsuccessful, and because of a nasty blood infection after the second one, decided not to have a third. Currently, I have a low EF (40%) and a dilated aortic root (5 cm). Notwithstanding, I feel pretty good and go to the gym just about every day for a vigorous 30 minute workout on the elliptical, as well as doing reduced weights (more reps) one day a week for about an hour. I've been working out vigorously in the gym now for over 25 years. I take a beta blocker (Metoprolol) to keep my heart rate down, Xarelto to avoid strokes, and Lipitor to keep my cholestorol down. My blood pressure is very good, probably because of all the exercise. I generally don't feel any symptoms (including while I'm exercising) except when climbing lot of stairs or walking up long ramps, when I tend to get winded. So here's the question: Because of my low EF, I'm concerned about progressively developing congestive heart failure and possibly ventricular arrythmia as I age (my dad died of the latter after he'd had a heart attack at age 64; a recent stress test that I took showed no signs of coronary heart disease). In about 3-4 months, I'm due for a battery replacement on my pacemaker and am wondering if it makes sense at that time to consider having my pacermaker replaced with a 3-lead device. This would allow for bi-ventricular pacing, which I understand can improve the EF, sometimes significantly, and can help to ward off progressive heart failure as one ages. However, it's my impression from what I see online that this is usually not done when the EF is greater than 35%. I'm wondering what the experience of club members is in this regard. I'm also wondering about the risks associated with such a replacement; e.g. the possibility of damage to tissue in the vicinity of the old pacemaker and further blood infections. I will of course be speaking to my physicians about these issues, but would appreciate any insight members of this group may have on the matter. Thanks.
2 Comments
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the doctor chooses
by dwelch - 2019-10-24 01:15:41
A lot of folks ask about info about choosing a device. The doc should be choosing the device. I just switched from a 2 lead to 3 lead a few years ago and it not only stopped my EF from dropping it turned it around. But all along for like 15 years or so of echos every year, it was the doc worrying about it not me. When my EF dropped to a certain point we did a stress test to confirm that it was time for a three lead and pacer number four didnt get to live out its full life (it was supposed to be a 13 year device, oh well) and am on pacer number five with a new lead (four leads total on one side, one lead broke during first replacement).
going to a bi-ventrical device is half way between a normal replacement which I assume from your profile you have not had a replacement you are on device number one? and a new first time device. The first time part of it is a new lead, and at least one of my docs rules was if you get a new lead you stay the night, this latest surgeon was willing to send me home but I chose to stay the night. A replacement is a simple open the pocket unplug the leads, plug into a new device, put it in the pocket, sew it up and send you home.
Some surgeons (not all EPs/cardiologists are the surgeon that does the procedure, depends on your doc(s) and how their practice works) will open at the same place, some will make a new scar, its just how it is. The risk of infection doesnt change with a new device other than the surgery itself, no difference than the first surgery.
The devices are sized in part based on the tech used that year by that brand and the condition, so like me with a complete heart block where the ventricles are paced basically 100% of the time I would take a larger battery than a single lead patient with some other issue, likewise a bi-ventrical in my case is larger than a single (two lead). Thats just part of it. My first device 30 years ago was HUGE compared to the devices today. It is what it is.
So Yes a bi-ventrical can help with a low EF or an EF that is dropping. But that does not mean that it always can/will, your doc had better know if the EF dropping can be fixed like that. In my case it was very like that after almost 30 years of pacing with the same two leads in the position they were in, then unless the EF drop was from some other issue, it is worth trying a bi-ventricle. You are not 15-25 years with a two lead pacer though so I wonder if a three lead will help.
Short answer its not you who has to make the medical decisions, thats the docs job, it is in your interest to ask the questions and get the answers, be it yes it can help or no your EF drop is not related to uneven ventricle pacing. Generally the brand/leads/etc should be left up to the doc as well and in that case your job is to indicate what your activity levels are or you wish them to be, with the current pacer I cant do this, can we get one with a higher max and/or can we change my settings to allow me to do this activity better, etc.
In my experience my EF was on a steady decline over the decades of pacing and when it dropped below the 40s we started to pay very close attention then it got to the mid/lower 30s and it was time. Because of how the echo and doctors visit lined up I had to wait 12 months instead of 6 to find out if the pacer had done anything and as mentioned above not only did it stop the drop in EF it turned it around and it had jumped up. The EF drop in my case was very likely due to almost 30 years with two lead pacemakers. I have no experience with low EF due to other reasons and what a pacer can or cant do to help. There was a risk that it wasnt going to work in my case. I dont remember what the odds were maybe 70% chance it would help, I simply dont remember.