Does Cardiomyopathy affect accessibility to Coronary sinus vein
I’m scheduled for CRT-P surgery in three weeks. I’m 91 years old and had my 4th dual chamber pacemaker placed in March 2020. I have a history of cardiomyopathy, enlarged heart and atrial fibrillation. However, there have been no significant episodes of Afib for the past 6-7 years and it’s no longer an issue My meds include Carvedilol, amiodarone, furosemide, and pravastatin. I also have stage 3B kidney disease which has been stable over the past two years. My BP is now in the normal range without medication and my ejection fraction range is 30-35 percent.
A recent echo showed fluid in my lungs (about 45 percent). I also I have lymphedema in legs. My ep doctor told me that the surgery would first require a venogram with contrast to determine accessibility to the coronary vein, removing the dual chamber pacer, leaving the existing leads in right atrium and right ventricle, and placing a biventricular pacemaker deeper in my chest. I have paper thin skin and the pacer that was placed in 2020 has shown one area with only a thin layer of skin covering it so the new pacer will have to go deeper if possible and probably with a larger pocket. That’s up to the surgeon. My concern is with the venogram. If the test shows that access to the coronary vein is not possible the surgeon will not be able to place the third wire to the left ventricle using the endocardial procedure. I know the epicardial method is an alternate option, but I would prefer the pacemaker implanted in the upper left part of my chest plus the epi would be a longer surgery.
The upgraded biventricular pacer is important for me. Not so much to give me a longer life—I’ve already achieved that by waking up every morning for 91 years, but I want to have a better quality of life. I understand that most people have successful venogram outcomes and I hope I will too, but I want to know if my enlarged heart affects the condition of the coronary vein—opening, angle, width etc. I’m confident, based on what I’ve read that most venograms work out well, but I’d appreciate any input regarding my concerns.Basically, does my cardiomyopathy or enlarged heart affect the condition of the coronary vein.