Ventricular pacing

Ventricular pacing

by grilor - 2016-10-01 14:36:19

I have had my pacer since September 12 of this year for complete heart block or 3rd degree heart block. My ventricle is paced at 100%. I understand that while it can cause some CHF later on, we dont have much choice. I think everyone in complete block is paced at 100% I have also read that there are folks that have been paced this way for many years and not had much problems.

Ventricular pacing

by Bostonbionic - 2016-10-01 15:25:31

hi 

i had my pm put in March this year and like you was very active. You have the same percentages as I do. I had heart block type 2. I had 5 months getting mine adjusted as I felt my heart beating and skipping mostly at night and it does panic you. I had my ventricular pacing reduced so it kicks in just before a second and my sensitivity lowered. Turned all self check modes off. My lower rate is 40 bpm . Yes we do need to know that we have something that helps us but you can also keep a check on your ejection fraction which is how well your heart is working so if you don't know it ask for it. Usually it's a ultrascan. I think it should be 55 to 75per cent. I'm sure others in here will know more. Keep exercising and a healthy diet and take magnesium good for the heart. Get a print out of your readings and ask questions it's your heart. Saying that I found everyone on this site more knowledgeable that's some doctors.

hope that helps.

liz uk

Ventricular Pacing

by Good Dog - 2016-10-01 15:58:14

Boston Bionic; It seems that you are doing your homework. You seem to know what is important. To answer the orginal question, no, 38% is not a significant amount of ventricular pacing. As Boston Bionic said, you should ask your doc and keep track of your Ejection Fraction. A normal EF ranges from 55% to 70%. However, that doesn't mean that 40% is bad necessarily. It is an inexact science.  It is true that too much pacing of the ventricle can eventually cause Congestive Heart Failure. However, it happens only in a small percentage of folks. So it isn't a sure thing. My ventricle is paced 75%-85% and I have been paced for 30 years. So far so good for me.

There is a guy (Terry) that posts here occasionally and tries to convince folks to get a more natural pacing method of the ventricle. It is called HIS Bundle Pacing and it is actually proven to reverse Congestive Heart Failure. With HIS Pacing there is no lead in the ventricle. There are two in the atrium. So supposedly, that method will eliminate the dangers of conventional ventricle pacing. However, it is difficult or next to impossible to find someone to do it for you. I asked a lead doctor at the Cleveland Clinic and he did not want to talk to me about it. They have no interest. My current doc has no interest. My curent doc and I think that most docs have been trained in certain methods and they usually won't deviate from them. If I could find someone here that would do HIS pacing, I'd certainly go for it. One of the beautiful things about it is that the leads do not pass through your tricuspid valve. In addition to the obvious benefit, that one also is significant, because that valve can be easily damaged in any number of ways from conventional pacing.

In any case, pacing of the ventricle is something you should try to minimize, but then not worry about it, because it is beyond your control.

Sincerely,

David

BTW: here is a link to a short film on HIS Pacing - https://www.youtube.com/watch?v=-WALkANaU30

pacing

by Tracey_E - 2016-10-01 16:08:14

Do you feel good and can you do what you want to do? If the answer is yes, then you are pacing the right amount. No two of us are alike and there is no magic percentage that is good or bad. 

Unnecessary ventricular pacing is bad. If it's necessary, it's necessary. The heart being out of sync is hard on the heart, also. The way they place the leads has changed over the years so it's easier on the heart, and any decent doctor will automatically adjust so you pace as little as possible. Yes heart failure happens sometimes, but there are treatments for it and it's not that common.

I don't really worry about it. Without pacing either I wouldn't be here or I'd have no quality of life. With it, I feel great and can do whatever I want. We are all well monitored and I take better care of myself than many friends my age. I figure being fit and well monitored but paced is still pretty good odds. I've been paced every beat since 1994, been through 5 devices. am healthy and active and my EF hasn't dropped at all. So far, so good :o)

GoodDog

by BillH - 2016-10-01 20:06:19

I wonder when you ask about HIS bundle pacing at the Cleveland Clinc?

I follow a number of cards and EP's on twitter. I see more and more doctors posting a an example of an EKG with HIS pacing and indicating that it was not that hard to do.

Use the tag #dontdisthehis on Twitter and you will find a bunch of activity.

And I see that Medtronics is doing a webinar on this on Oct 13. And that is big because HIS pacing will cut into the need for CRT devices.

And the current issue of "Journal of Electrocardiography" has 6 articles on it.

Cleveland Clinic

by Good Dog - 2016-10-01 20:29:21

I asked last year (Oct 2015). It is interesting, because the doc told me that they prefer to use CRT. It made me doubt the value of the procedure, but in this past year I have been reading more and more about it. They are considered one of the best cardiac hospitals in the world, so I am really surprised that they hadn't caught-on to HIS Bundle Pacing????????? They are a huge buyer of CRT devices! At the time I was thinking that they are such a big organization and that someone will have to make a command decision which probably wouldn't happen overnight. Not sure what to think???

V PacingHIS

by Bostonbionic - 2016-10-02 07:45:19

Thanks GoodDog for your comment. He is correct regarding  HIS bundle pacing I also read about the benefits this has. However most of us when we first get a pacemaker we have no idea about implants and how it works. Usually it happens when we least expect it so we are not sure what questions to ask etc. We accept the medical worlds decision as they are the experts. It's only after we learn so much about them. I'm not sure if they do HIS bundles in the uk most just use the standard method. 

Liz uk

Thanks

by PeterL - 2016-10-02 07:45:38

Thanks for advises. Last time I had an echo my EF was 59, so it’s ok. Will ask the doctor at next checkup regarding some changes for the ventricular pacing.

For now I feel me not so well, but it’s more likely not pacemaker issues – my heart rate rises a lot when I’m standing or doing some daily activities. But I think, it’s most likely some side effect after mono I had 5 months ago and hope that this will end with time.

Thanks a lot for your help :)

HIS Bundle pacing UK

by IAN MC - 2016-10-02 08:38:55

Liz I agree that most of us " are in the dark " when we have PMs fitted. I wish that I could wind the clock back with my current level of knowledge to the day i was given a PM 5 years ago . I think I would have probably ended up with a slightly different outcome.

You mention the availability of HIS bundle pacing here in the UK. I believe that most usage of the technique is being done as part of clinical trials. I know that the British Heart Foundation is currently sponsoring a multi-centre UK trial looking at the possible benefits of HIS Bundle pacing in patients who have experienced some degree of heart failure . Two hospitals not too far from me, the Hammersmith in West London and a hospital in Watford are involved. and are after recruiting 160 patients.

I think that the actual location of PM leads is something we will hear far more about in the next few years and accepted clinical practice may well change.

Ian

Good News

by Good Dog - 2016-10-02 09:16:02

That is good news for me. I mean the possibility of HIS pacing going mainstream. You may wonder why? Well, since I have two very old leads in my ventricle (obviously, one is capped), should the active lead malfunction I cannot have a third lead inserted through the valve. Currently the only alternative is to extract. While there are less risks today than in the past, it is still very risky. Especially given the age of my leads. So a new lead to pace my ventricle without insertion through the valve could minimize the risks including perhaps the risk of possible CHF someday. So the possibility of HIS Pacing is very, very important to me.

GoodDog

by IAN MC - 2016-10-02 12:25:48

David : I hadn't realised till reading your post that HIS bundle pacing avoids the need for a lead going through the tricuspid valve,

I have always found that cardiologists don't really want to talk about this. I had an Echo and my guy told me that I was now having regurgitation around the valve presumably because of the wire which stops the valve from closing properly. He dismissed this as " not being clinically important ".   I am not so sure and I really would prefer to have  a tricuspid valve which doesn't leak !

Cheers

Ian

Ian

by Good Dog - 2016-10-02 15:52:03

Yeah, the real beauty of HIS Pacing (at least for folks in our shoes) is the fact that the lead doesn't penetrate the valve. They tell me that it is normal for the triscupid valve to have "some" leakage. Not sure how they quantify that? I agree with you in that I'd rather not have any. 

HIS bundles in the uk

by Bostonbionic - 2016-10-02 17:17:32

Hi Ian interesting what you say about HIS bundles trials in the UK and why this is not practiced more in all London hospitals. I had mine done at st.barts a heart hospital that still did it the old fashion way.. I don't think it's normal for the triscupid valve to have some leakage maybe someone can advise us on that. What are your symptoms? Would you have not known without the echo? Hence the reason we should always ask for a second opinion. Usually things we never noticed before the PM flutters extra beats and so forth we are much more aware now. I had ectopic beats I could really feel at night they wanted me to go on beta blockers when I insisted they delayed my ventricular pacing it suddenly got less and less. I do still get them but nothing like it was and I am at the age my hormones too have an impact going through the menopause. Even medication can change a hearts rhythm. Does anyone have any exact facts on the probably of heart failure due to excessive pacing done the old fashion way. In general we have the leads where they are so unless we need them changed and we are ok and can continue life normally then always monitor your situation and question any of your concerns.

liz uk

Liz

by IAN MC - 2016-10-02 18:17:58

You ask some interesting questions .I did have an  Echo in the various tests prior to me having a pacemaker and no mention was made then of tricuspid valve leakage , This was only mentioned after another Echo post-PM so I can only assume that the PM lead caused it.   Allegedly, mild cases are not particularly symptomatic  !

Commonly documented symptoms are declining exercise capacity and shortness of breath with activity. All I know is that having a PM brought an end to my marathon running because of those symptoms and Rate Response has never brought my exercise capacity to previous levels. I will never know if it is the lead going through my tricuspid valve which has contributed to this decline in exercise capacity or not. (  I blame Brexit ! )

You ask for data on the associated heart failure risks of ventricular pacing. If you Google " Medtronic Managed Ventricular Pacing " you will find stuff selected from various clinical trials and quotes such as :_

'" When ventricular pacing is less than 40 % , for each 10% increase there is a 54 % increase in the risk of heart failure hospitalisation "

" The risk of atrial fibrillation increases linearly as the level of ventricular pacing rises from 0  % to 85 % "

It all sounds scarey but I think Tracey puts it into context in her reply . As she says without ventricular pacing many of us would either not be here or would have a pretty miserable quality of life.

Ian

Numbers

by Tracey_E - 2016-10-03 09:48:16

Ian, taken out of context those numbers seem scary but I guess I have trouble getting too worked up about it. A 54% increase in the risk of heart failure, but starting at what risk factor? If starting risk is 10%, that's a big difference than if it's 0.01%. 

Forget the studies, look around you here. How many of us here have been paced every beat for many years, yet we are not in heart failure or afib? I'd say we're a pretty good sample. Yes some end up with afib or hf, but I don't think as high as those numbers suggest, well under 10% at a guess.