Ejection Fraction

Hi Everyone,

I had my pacemaker first placed on Halloween October 31st, 2021.  Right before Thanksgiving I had to have a Revision because the top lead had dislodged. For almost 2-months I was having shortness of breath (especially using the stairs), my chronic cough continued and I had gained a lot of water weight.  My PMD wanted to send me to a lung specialist for my cough. Turns out I had heart failure and just before Valentine's Day I had a 2nd Revision as the lead dislodged again!  I'm seeing a pattern here with Holidays?!! 

Recovery is slow after 2nd Revision. I still have no energy and have fatigue with my chronic cough. My EF was 20% at procedure and 4-weeks later it is still 20%. Normal range is 50-70% I'm told. 

I'm so frustrated with all of this going on. If the the big thing is increasing my EF number how is that done?  Medication? Should I try walking more steps each day (even though it's hard with no energy)? I always have to wait weeks to get in to see any of my doctors so can't get my questions asked in a timely manner. Anyone here have same experience or know more about EF? What can I do? 

Thank you. 


Ejection Fraction (EF)

by Gemita - 2022-03-18 09:07:40


I am sorry to hear of your difficulties.  You shouldn’t have to face these on your own without adequate support from your doctors.  With an EF of 20% you should have been given a care plan from your doctors for immediate treatment to support your heart failure.  This might include medication and other treatments (like cardiopulmonary rehabilitation, to try to help with your symptoms).  It might also include an upgrade of your pacemaker to CRT (cardiac resynchronisation therapy) with a defibrillator, the latter to protect you from a dangerous arrhythmia.  But all of this needs to be discussed with your doctors (unless you already have this type of pacing system)?  You don’t give us any info in your Bio history.

I would go back to your doctors and ask them how you can best manage your symptoms, to prevent your heart failure from getting worse, particularly since your EF is so low.  My sister is in heart failure with a very low EF (16%).  She is presently managed with medication only.  Like you she is far from satisfied with her care and we are all concerned for her.  (We are in the UK).

I would not push yourself with any activity until you get some answers about what you can safely do.  Will your EF improve?  It depends on the cause and whether the cause can be treated successfully.  Re-testing of EF is usually done after about 3 months of treatment with medication, but it may take longer to recover, so you will need to be patient, but there is a lot that can be done to help improve symptoms (lifestyle, medication, rehabilitation courses).

I wish you well and never stop believing that this will get better.  

EF 20%

by TAC - 2022-03-18 11:12:16

Unfortunate you're suffering from heart failure probably stage C or D. It's not just having a low EF. Your heart is weak and unable to pump out the fluid that is accumulating in your lungs, and other parts of your body. That's why you feel weak, have swollen legs and chronic cough. Heart failure is a progresive condition that might have started a long time ago. Your HF should be the main concern and only a heart doctor can tell you about what to expect in the future and whether there are additional therapeutic measures available to you. Your PM was probably implanted to guard off dangerous arrhythmias as part of your HF treatment. Contact your cardiologist.


by Terry - 2022-03-20 20:10:28

Gemita makes a good point. The electrophysiologists that I know of can accomplish CRT with one lead to activate the His bundle. His bundle pacing is the only physiological pacing method. Think of the His bundle as a bundle of nerve fibers terminating at hundreds of sites within the powerful ventricles. The ventricle walls are activated form inside to out, and from the apex to the base of the heart, with the left ventricle contracting a bit ahead of the right ventricle. 

There was a time when all doctors would plop the lead into the right ventricle and if satisfied with the electrical parameters, the pacemaker would be implanted. Why is this not the best option? It's hard on especially a weakened heart because the cells at the lead's electorode site contract, pulling heart muscle toward the electrode. Then, as the contraction propagates form cell to cell, more and more of the muscle is drawn toward the electrode site, resulting in extreem muscle fiber strain away from the elctrode site. Studies show that the result is hypertrophy away from the electrode and atrophy at the electrode site. What your doctor calls "pacing induced cardiomyopathy" can result in heart failure in 20% of patients paced in the ventricles more than 40% of the time, after five years of pacing according to the Geisinger Study,




by Good Dog - 2022-03-22 14:53:33

I agree with Terry. He knows what he is talking about. I don't understand why your doctor (EP) is not following-up with you for additional treatment. Perhaps he may have and you just did not indicate it here? It sounds as though a CRT is in order and as Terry pointed-out, the third lead can be burrowed-in at the left bundle branch. I know so little, which is why I cannot and should not offer any advice beyond the need to see your Doctor. I guess that my point is that you need to push your doctor for answers on further treatment. What is your care plan going forward? You need to know! If you insist that you need to know and he doesn't provide a plan to remedy your low EF, then you need to find a new Doc asap. 

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