Long-term Effects of Dual Chamber Pacing

Long-term effects of Pacing

by Good Dog - 2016-06-10 09:11:47

I can only tell you what I have gleened from reading published material on the internet and anecdotal info my my Doc's.  Much of what I read is over my head and some is very conflicting. So please take it with a grain of salt. I don't claim to have a good understanding and sometimes misinformation is worse than none at all. However, nobody responded to your question so I figured I'd try. There is quite a bit of info available on the internet contrary to what you indicated. Although, there is controversy surrounding this matter.

There are many different numbers from many different studies relative to heart failure caused by pacing over a long period of time. Generally, I have read that it is (HF) somewhere between 10%-15% (may be higher or lower). There seems to be different causes, but generally I understand that the greatest cause is simply pacing the ventricle (artificially with a PM) and dyschrony between the chambers resulting from pacing. 

Your Doc should be monitoring your ejection fraction to determine over time if there is any concern. The EF is an indicator of how efficiently your heart is pumping. A normal EF is 55% - 70%. 

I have been paced for 30 years and my EF is still in the normal range. I recently read that there is some demonstrated benefit to a lower pacing limit over time. In-other-words, a study indicated that someone with a low pacing rate (setting) of 40 bpm is less likely to end-up with HF than someone with a low setting of 60 bpm. However, the problem is that a low setting of 40 bpm may cause many people to be symptomatic. In any case, supposedly, the less you are paced, the less chance there is that you'll end-up in HF (I say "supposedly", because I don't know). 

There is a method of pacing called HIS-Bundle Pacing that has been demonstrated to not only prevent HF, but even reverse it. However, most cardiologists won't do it. With HIS Bundle pacing both leads are placed in the Atrium instead of one in the ventricle and one in the atrium. One clear benefit is not having a lead placed through the tricusbid valve. Anyway, I spoke with a Doc at the Cleveland Clinic and they are stuck on the 3-lead CRT method (to remedy heart failure) instead. They are resistent to utilizing the Bundle Branch Pacing  Procedure. There are other hospitals such as in Wilkes-Barre, PA that are using that procedure.

So what you should take-away from this is that the chances of having a problem from being paced over the long-term is actually small. You should have good communication with your cardiologist to get a comfort level relative to your EF over time.

Sincerely,

David

Third Pace Maker

by orangebowls - 2016-06-10 19:17:07

Hi  in your post you said you are on your 3rd PM since 2012, I know you are being paced 100% due to av ablation but, why are they running out of battery so quickly?   

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LTE of Dual Chamber Pacing

by BDas23 - 2016-06-10 19:26:34

Hi Renae! 

       That's a great question! I'm in the same boat as you. I've had a pacmakerr since 1995 after an AV node ablation.

        In general, there are side effects to having a pacemaker for any period of time. These can occur regardless of pacing type.

These are the most common:

lower cardiac output, dizziness, syncope,confusion, hypotensive (bp) changes, chronic fatigue, arrythmias, and in rare cases HF

        From my understanding,  you might experience these side effects at some point of time with a pacemaker, but these usually go away after adjusting pacemaker settings or medications. In some cases these side effects will persist, but are less frequent due to having a pacemaker. It really varies by individual.

         If you have many of the above symptoms listed over a long period of time, then this is referred to as pacemaker syndrome.PS is caused by dssynchrony of the heart chambers. Dssynchrony is a consequence of having a pacemaker implanted. In most cases PS is due to AV dssynchrony (too long of a delay between the atrial and ventricular contractions). 

          This PS has been known to occur in patients with slower heart rates such as patients who are post AV ablation. Unfortunately, PS is highly underdiagnosed & there isn't any set diagnostic test to look for it. 

The good news! PS can be treated with the placement of an additional lead (3rd lead if dual paced), adjustment of pacemaker settings, upgrade of pacemaker device, diet changes (depending on symptoms & risk factors), or treatment of individual symptoms until PS is managed. 

After speaking to a few cardiologists & med professors, LTE of dual chamber pacing isn't studied because they don't have a high number of patients that are paced over long periods of time (over 10+ yrs). I think (not 100% sure), about 70%-80% of pacemaker recipients are above 65 yrs old. Only around  10% are under the age of 30. 

I hope this helped a little bit. Have a great day!

Pacemaker syndrome

by golden_snitch - 2016-06-11 03:41:45

Sorry, but this is not correct. PS = pacemaker syndrome refers to an AV dyssynchrony, but the heart failure sometimes caused by right ventricular pacing is due to a dyssychrony between right and left ventricle, not atria and ventricles. What you see is typically a left bundle branch block, the left ventricle is activated much later than the right (which is paced) and this is what leads to a reduced EF. If this is the case, it helps to add a third lead to pace the left ventricle. A third lead does not help at all when you have PS caused by an AV dyssychrony (in patients with a single-chamber pacemaker and PS it helps to add a second lead, though). In patients with PS and a dual-chamber pacemaker it helps to adjust settings (AV-delay for instance).

Not everyone who's paced a lot in the right ventricle at some point goes into heart failure. The numbers I have read are around 10% of all patients. And it's not that is only happens after longterm right ventricular pacing, but there are also patients who go into heart failure after just a couple of weeks or months. Researchers still haven't figured out why some pacemaker patients go into heart failure and others not, but one aspect that seems to be important is the pacing site. You see heart failure more often in patients with apical right ventricular pacing. So, alternative pacing sites are being evaluated, for instance septal pacing or His Bundle pacing.

Thanks

by Good Dog - 2016-06-11 07:49:34

Golden Snitch...............excellent explanation..................thanks for clearing that up! As I had said; "misinformation can be worse than no information"

Thank you.

by Renae - 2016-06-14 21:14:33

I really appreciate your comments. I have been a "robot" for years with no problems and this is the first time my illness has frightened me.  To clarify, the first PM was in 1999.  That device was recalled and replaced in 2005.  The third device was placed in 2012.  They are 10-year batteries, but being paced 100% burns through the battery pretty quickly.  I still have the original leads with no problems noted as of yet. Once again, thank you very much for taking the time to comment on my post.

long term

by dwelch - 2017-06-23 03:25:19

I know this is a really old post, but I am very much on topic.  30 years with a pacer, at around 20 years they started doing an echo every year, watching my EF (ejection fraction).  Hovered in the high to mid 40s but then went down below into the 30s.  And now they have three lead pacers.  And that is exactly what happened my EF dropped to low 30s we assume do to 30 years of pacing from a dual chamber pacer.  Now have a three lead/bi-ventrical pacer, 70% chance that this will reverse it.  If it is going to happen it is going to happen within 6 months.  So I am still waiting on the outcome.

Also, long term issues based on what i was told this time around.  Risk of issues with lead remove goes up from 1% chance of issues to like 3%.  I dont remember if that was at the 15 year mark or 20 on average.  Fortunately there was room (I have a broke lead in there) four four, one broken three I am using, so didnt need a removal and/or a tunnel over to the other side.

You asked this a year ago so you are 18 years in now,  if not already they should start checking your EF annually.