1 lead vs. 2 lead PM

I've written before and got some helpful comments. Maybe I will receive more regarding my present condition.
3 yrs. ago I got a PM w/1 lead wire . For the last year or so
I have been short of breath and unable to walk more than a block or 2. After many tests my cardiologist said a 2 lead PM
would probably solve my problem.
I am 77 years old. Is Smitty still around to give any advice?
Steve

6 Comments

One vs Two Leads

by SMITTY - 2010-10-18 01:10:40

Hello Steve,

Yep, like a bad penny, I show up every day and read the messages here. But my main advice for you is do as the doctor says.

I have some understanding of the 1 vs 2 or 3 lead pacemakers, I'm going to guess, and let me repeat, I'm guessing, that your current pacemaker is pacing only the atrial and now the ventricle needs a little help so that is where the second lead will go.

I'll try to give you a little better insight in one and two chamber pacemakers. First let me say if I insult your intelligence about this I apologize right now. But lets start with an over simplified comment about the blood flow pattern through our hearts. Our heart has two upper chambers and two lower chambers. The upper chambers (atrial) receive oxygenated blood from the lungs. The hearts natural pacemaker sends an electrical impulse to cause the atrial to contract and "push" the blood into the lower chambers (ventricle). The ventricle then receives an electrical ampules from the hearts natural pacemaker, contracts and sends the blood throughout out body.

Most often (but not always) the atrial is the chamber that needs help from a pacemaker. For example, my pacemaker paces my atrial more than 90% of the time and the ventricle about 5% of the time. So if your one lead pacemaker is pacing the atrial then it is possible the ventricle now needs a little help from a pacemaker to get the blood from it out into the body. As I understand it, our heart is the biggest user of blood, but it will try to send blood to other parts of the body first and as a result will short itself on blood supply. The heart not getting enough blood flow is one of the causes of shortness of breath. So giving you a pacemaker with two leads is a way to get another chamber pumping a higher volume of blood to all parts of the body and give you some relief.

With that I'll stop. If you have any specific questions let me have them and I'll be glad to try to find an answer for you.

Good luck,

Smitty

Single lead vs 2 lead pacing

by ElectricFrank - 2010-10-18 01:10:55

Single lead pacing can take on two different approaches depending on the problem. As Smitty mentioned it can be configured to pace the atrium when the natural pacemaker isn't functioning properly. For this to work though the AV node must be intact and able to signal the ventricles to contract.

If the AV node is not working then the ventricles must be paced directly. With a single lead the Rate Response of the pacemaker is used to determine the ventricular rate and the atrium is left to itself. The disadvantage of this method is that the atrium and ventricles aren't synchronized, which doesn't make for optimum pumping.

The more common approach is to use 2 leads where the atrial lead senses the natural pacing and uses it to time the ventricles. If your problem is only due to an AV electrical block this type of pacing is very natural.

There are several studies out of Europe showing that the use of single lead ventricle pacing has a better cost-effectiveness ratio, which is a way of saying "we don't give a damn how it feels if it keeps you alive and is cheaper" (My feelings).

best,

frank

two leads

by #1grandma - 2010-10-18 08:10:15


Hi Steve,
I had a two lead PM implanted on the 12th of this month. Before my surgery my breathing was getting so bad that I couldn't walk from the livingroom into the bedroom without gasping for air. It had gotten so bad that in trying to walk my legs would quit working. Now, after surgery, I can breath normally. Yesterday I was able to go for a walk out of doors with no problem. I feel like I have a new chance at life and I am thankful to be here!

Good luck

Sally

Thanks!

by #1grandma - 2010-10-18 08:10:23

Thanks Smitty and Frank for your information. It was helpful for me too.

Sally

Going for walk

by ElectricFrank - 2010-10-19 01:10:26

I can sure relate to that. The whole world looks better after an outdoor walk.

frank

2 is better than one

by Dvd - 2010-10-26 01:10:09

I'm new the group ( joined today) but like Smitty, I try to do allot of research on the subject. I learned a long time ago cost and insurance companies have allot of influence on which devise is used, one lead vs two. It has been shown that the muscle on the side being paced is effected in many ways including contracting stronger than the other side and over time can weaken the un-paced side. That's when the second lead really helps to equal things out. It has been suggested that if the PM is going in a person expected to need it longer than 2 years, that two leads should be put in place from the beginning making it possible to keeps things in balance avoiding the muscle tissue imbalance in the first place.

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