Echo scan

Hi Guys ,  been for my check up today I have a duel pacemaker it will need replacing in under a year not had it replaced befour i have complete heart block, I'm a bit worried as the nurse said they will book me for a echo scan befour they change the pacemaker in case I need a third lead  !!! Now I'm really worried I'm going to need another lead ,  is it routine or do they see a problem ,  can anyone advice pls .  thankyou 


Echocardiogram scan

by Gemita - 2020-05-27 13:50:12

Hello Katz,

It sounds to me as though you are not getting much feedback from your clinic  and I would be asking them if they see a problem from your pacemaker check today ?  Do you have any symptoms Katz, like breathlessness, fatigue?

I believe before any procedure, including a device replacement, this would require a pre-operative assessment of your general health and particularly the health of your heart. An echocardiogram will give them a lot of information and help them to decide how well your heart is performing.  They will look at your heart's chambers and valves and assess your ejection fraction.  Then if they find your heart needs a third lead this can be implanted at the time of your device replacement.  But I would really be asking lots of questions Katz because it is important that they explain to you what is happening so that you can be an equal partner in your treatment.  Hopefully you wont need another lead, but if you do, a third lead could make a big difference and improve your quality of life.

Good luck


not after first device

by dwelch - 2020-05-28 02:34:30

It is possible over time that being paced with a pacemaker can mess with the heart muscle in a way that eventually you may need a biventrical pacer.  This is exactly what happened to me recently.   30 years give or take and my EF was dropping slowly over that time then it hit mid to low 30s and they called it, three lead device.  But I had like 15 years of echos every year to watch for this.

What I suspect is that in your case this is a procedural thing, to avoid this lawsuit or that, all patients in this practice or in this hospital or under this insurance plan or in this country must have an echo before a pacemaker replacement to look for x and y and z.  Kinda like when your brand new electric toothbrush has a pacemaker warning, legal insurance, in the case of the toothbrush, ink is cheap.  In the case of an echo, they can bill insurance for the procedure.  If you are getting a new pacer then there is a pile of money somewhere paying for it, so this would be not quite in the noise, but almost in the noise for cost.  If you started to have symptoms they would start echos and maybe find something.  My fourth pacer's life was cut short like 3-4 years (would have been 2-3 but I had issues that prevented me from getting in for my stress test).   The cost of an echo vs the cost of a device not living out its life is a noticable cost to the insurance company.  My EP mentioned that she expects that insurance will not allow for elective replacement, meaning well it says it has a few months my kid is getting married around that time in hawaii so can I have the replacement now so I am able to go?  She expects that they will not approve the replacement until the device goes into safety mode.  If they insurance companies are getting to that level then balancing the cost of an echo vs a device losing years of useful life because a biventrical is needed.  Easy math. I wouldnt be surprised if some companies start doing echos every year from before your first device on.

A third lead aint no thing any more than two leads.  heart runs even better they can individually tune the left and right signals rather than have one drive both sides in a kind of wave across the heart.  

Now folks at this site talk about placement and even though pacemakers were not completely rare exotic things when I got my first one, there has still been improvment all the way around since then including routing of the leads and placement.  So dumb luck or otherwise your placement may be such that this doesnt affect you for a very long time.  Or maybe it will and you may need a lead.  Read posts from Tracey_E and others and both of us have outlived our leads, statistically, two leads or three might have to start swapping those out.  And if you start young enough and live long enough they might have to abandon the one side and move everything over to the other side.

I would expect somewhere during device number three they start asking you to do an echo once a year.  Not just before device number four.  Come back in 15 years and we can test that theory...

An echo is not as quick as a pacer check, you lay down, they move the thing around your torso for a bit.  Sometimes they dont warm the gel and sometimes its in a small not that well ventilated room so the room is hot.  But it aint no thing, nothing to worry about.

I bet if you do call which there is no reason not to, you wont get much further past the nurse, and the answer will be "it is policy to do an echo before any pacemaker replacement", done, period, no worries.


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