Does Cardiomyopathy affect accessibility to Coronary sinus vein


Hi, Everyone:

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.

Thank you.


You're letting your anxiety control your life

by crustyg - 2021-11-14 15:58:46

Don't misunderstand me, I also have serious trust issues (which provokes anxiety before a medical procedure), but in the end you have to trust the experts that you've chosen.  So you should let the experts worry about the venogram and access to the coronary sinus.

In my simplistic view of cardiomyopathy, there's H(O)CM and DCM (and the metabolic/acquired types).  I *think* HCM makes the anatomy more difficult but I really don't know for certain, and I suspect that if you have HCM you wouldn't have made it this far.  Getting a normal trans-venous pacing wire into the coronary sinus is as much about the skill of the operator (and choice of lead) as it is a function of the patient's anatomy.  But you have to accept the cards that life deals you, and imagining all the things that *might* go wrong now really doesn't help you.

I don't think it's essential for an epicardial LV-pacing to force PM placement lower down the body - I think tunnelling is perfectly possible - but many young patients spend 10-20 years with an abdominal PM without issues.  Not everyone can have their device placed where they would prefer.

If you've ever had CBT for your anxiety, now is the time to review and remember it.  *NOT* visualising the near future really does help, distraction is better and more helpful.

Best wishes.

Thank you

by Rxrich - 2021-11-14 17:27:15

Thanks Crusty for your suggestions--I spend too much time researching the procedure. I know the basics of what it entails so, you're right. I just have to let it go. I have a history of severe anxiety and panic disorder.---couldn't deal with imaging issues---CT scans etc. and always felt I was in danger when I really wasn't. You mentionred CBT. About two years ago I read a book on cognitive behavior--this book really nailed it for me and helped me acheive the impossible, basically dealing with the "triggers" by toughing it out--sticking with it for 10 or 15 "long" minutes until I was safe. Sometimes in bed I would experience free floating anxiety that wouls consume me. I used to get up and go in another room or turn on the TV etc to escape from my anxiety instead of facing it and dealing with it---Using CBT I stayed in bed and toughed it out until I was calm again--once I discovered it works changed my life--it was so simple. I really knew that was the answer  before I read the book but was always afraid to tough it out because I didn't want to go through the agony--but going through the agony one time convinced me CBT works. Getting out of bed and not sticking it out only sent negative messages---it told me that when I had a panic attack or anxiety I should get out of bed---the right thing to do was to stay in bed and deal with the sweat, racing heart etc which is what I did--Was nat easy---and becasue it was not easy is what made it work for me---there is no shortcut. I stay in bed, distact myself counting backward, taking my pulse for 30 beats on each wrist over and over---in 10 minutes I was calm and with a smile on my face---it was so easy. I don't question why I didn't do it for years. It didm't matter--I do it now. So that's it in a nutshell. I think I was filling in the blanks about the surgery--trying to anticipate what might happen---your suggestion reminded me of what I had to do--nothing--forget all my tresearch about the procedure and get on with my life. I never question good things--just accept. I was wasting time searching for every last detail--not a good thing. Delving into the small details about the surgery didn't create any of the usual anxiety symptoms--sweat--racing heart etc. I just had to know everything about it but I really don't--Like life itself---nothing is perfect but CBT works for me most of the time and that;s good enough---thanks, Crusty

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As for my pacemaker (almost 7 years old) I like to think of it in the terms of the old Timex commercial - takes a licking and keeps on ticking.