Pacemaker induced left ventricular systolic dysfunction

Good morning everyone,

I'll try to make my question brief, despite the lengthy subject title.

I had Medtronic dual lead PM implanted three months ago (along with a TAVR, the day before). I am 100% paced. 74 years old.

I had an echocardiogram last week with my local cardio. He called me in to discuss it. My ejection fraction went down enough that he was concerned  and is scheduling a nuclear stress test to determine if my 80-90% clogged coronaries need stenting. The stress test was originally to take place after my cardio rehab, but now moved up.

I have no medical training, but researching online, learned about pacemaker syndrome (PICM). Given the timing of the PM implant and the decline in LV ejection fraction, I think I fit the pattern. Local cardio said it was not PM related (I asked before I read about PICM).

Of course, it could all be from the clogged coronaries, but, so soon after the PM?

Can anybody recommend the better hospitals for diagnosis and treatment of PICM?

It seems to be a complicated and uncommon  diagnosis.

I live in Northern New Jersey, very close to NYC. I also have family in Baltmore, if Johns Hopkins becomes  the super best choice.

Thank you so much.

Fred


11 Comments

a theory

by Tracey_E - 2024-01-10 08:49:53

I'm no doctor either so this is just an amatuer theory, but could the better circulation now that your heart is beating normally be causing the clogged arteries to rear their head? 

Sometimes adjusting the settings can reduce the amount of pacing.

Between NYC and Baltimore, you have a wide array of superior care to choose from. 

Are you seeing a cardiologist or electrophysiologist? Cardiologists are plumbers and the best to deal with the clogged arteries. EP's are the electricians, they are the best choice to deal with pacer settings. 

I would deal with the arteries first, then find an EP to discuss your pacer settings and go from there.

Self diagnosis

by Gemita - 2024-01-10 08:52:43

Fred, I can imagine your concern.   

You appear to have made a self diagnosis which is not always wise.  My feeling is that you need to wait for the results of your nuclear stress test and possibly an angiogram (gold standard test to diagnose coronary artery disease) to look directly at any artery which might be narrowed, blocked or diseased, before you go rushing into self diagnosis and a treatment plan.  

You first need to find out whether your arteries are blocked and need stenting and whether this treatment alone will help treat your LV systolic dysfunction.

I see you have had a transcatheter aortic valve replacement and your doctor had hoped that by now your LV systolic function would be showing signs of improvement but this doesn’t appear to have happened.  Until they have fully assessed the potential cause or causes, I am not sure that I would seek a different opinion, unless you no longer have trust in your team?  Do you know by chance what your EF (ejection fraction) is now?

Difficult

by piglet22 - 2024-01-10 09:03:04

You are in a difficult situation.

I think it would be best to rest up, stay with your present team and keep away from speculative diagnoses.

Tell them directly of any concerns you have as reassurance is the best course of action at the moment.

Easy to say, I know.

Good luck

complication

by fredaosss - 2024-01-10 09:14:08

Thanks to all who responded.

Gemita,

It went from 55 to 45

I would not be too concerned, but watchful

by Gemita - 2024-01-10 09:34:58

Fred thank you for your Ejection Fraction result.  

Allowing for echo operator experience and any difficulties in obtaining clear pictures and other variables, a 10% change may not necessarily mean very much.  In any event 45% is not dangerously low.  I would have confidence in your team that they are caring for you and you are not currently in any immediate danger.  They will be keeping a close eye on you, carrying out further investigations and watching that ejection fraction.

A left ventricle (LV) ejection fraction of about 50% to 70% is regarded as normal. A mildly reduced LV ejection fraction is usually between 41% and 49%. A reduced LV ejection fraction is usually 40% or less.

What you need now is to recover well and try not to get stressed since that will not be helping.  Meant to ask, how do you feel?  Have you noticed any improvements since your Aortic Valve procedure?  I do hope you steadily improve

3mm leads in a 4-7mm artery.

by Shroselo - 2024-01-10 13:16:03

In a healthy male arteries are 4-7mm wide, pacer leads are 3-3.5 mm wide which already takes up half the space available. Clog that artery and nothing is getting through. Im no doctor but I'd assume once you have the stents in you'll be running like a champ. It sounds like you already have a good team who are on top of everything and I personally wouldn't change doctors. Sounds like you already had some big issues prior to getting the pacemaker and this is all just part of the treatment plan. Pacemakers are not a cure all, just a fraction of the puzzle. 

Again I'm no doctor and I could be completely wrong, but based on the information I have this is just what I would do. 

better

by fredaosss - 2024-01-10 13:22:22

Gemita,

Yes, I do feel better than before the TAVR. Not as great as I expected, but better.

Thanks.

Veins versus arteries

by Julros - 2024-01-10 14:47:23

A gentle reminder that pacing leads are placed in veins, which do not supply oxygenated blood to the heart muscle. Yes, a lead may impede blood flow, but that does not affect LV functioning. 

 

Pacemaker induced LVSD

by Aberdeen - 2024-01-10 18:16:15

I had pacemaker induced LVSD four months (May 2020)after having a dual lead pacemaker implanted. My LVSD was sudden and I collapsed at home and had to go to hospital immediately. I then had a CRT pacemaker implanted.My EF was about 35%. Fortunately the CRT vastly improved my EF.

From what you have said it isn't similar to my symptoms. (I am not a doctor and have no background in medicine)I hope you get answers soon. 
 

PM induced

by fredaosss - 2024-01-10 19:12:29

Thanks Aberdeen, 

Glad to hear you improved. 

PM replacement procedure

by ambrom - 2024-02-04 17:31:20

My husbandI had Medtronic dual lead PM implanted in May 2022. Had EF of 25% in Aug 2023.with hear failure. TAVR was done in Nov 2023.EF has gone only up to 30%. Now the doctor says 3 lead PM CRT has to be inserted and the last one has to be removed. In other words PM replacement sergery has to be done. Did they make a mistake in inserting the original one in 2022 May? The eF might improve then says the cardiologist.

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