Complete heart block after 2nd ablation

worst case scenario

by Tracey_E - 2018-01-10 09:45:18

CHB is a risk of ablation, it does not mean they did anything wrong. Sometimes they get the good while trying to get the bad. At  the risk of being too blunt, VT will kill you long before being paced for heart block will so if that's what it takes to get rid of the VT, you are still better off than you were.

You already have a pacer in place so the good news is the heart block is already fixed and your heart is still beating normally. Your doctor was talking worst case scenario, not high likelihood. It's possible that over time heart function can drop from ventricular pacing, in which case they can add the third lead to synchronize the ventricles which can increase function.

I switched to a practice at a large teaching hospital that sees a LOT of patients who have been paced long term, and I see the head of electrophysiology. He said his best guess is reduced function from pacing happens less than 10% of the time, and if someone has been paced more than 5 years with no ill effects, then he almost never sees the function drop after that. If it happens at some point, between 3 lead pacing and medications, CHF can be well managed. But that is a small possibility and years off, if at all. I don't lose any sleep over it. Without the pacing, I'd have no quality of life so it is what it is. So far, so good, 24 years and counting. 

Ventricle pacing 100% of the time

by Debstinydogs - 2018-01-10 19:53:55

Thank you, Tracey, for your thoughtful response.  When you say the EP only sees reduced heart function from ventricle pacing about 10% of the time, I’m curious if that % includes when pacing is occurring 100% of the time?

Can you explain how I would know if I’m having decreased heart function?  Would I just feel lousy?  What type of test would reveal decreased function?

And, lastly, if I were to have decreased heart function, would the addition of the 3rd lead give me back what I lost, or might it be gone for good?

If there’s a chance I wouldn’t get it back, wouldn’t it be better to go ahead and make the change now, pro-actively?

Again, thank you for taking the time to enlighten me!

Debbie

pacing

by Tracey_E - 2018-01-10 21:01:00

Almost all of his patients pace 100%, that's pretty typical of CHB. So when he says less than 10%, I assume he means other patients like me. That's why I switched practices two years ago. I adored my other cardio, but he didn't have anyone else like me, relatively young and paced long term. 

When they do an echo, it measures heart function. My old doc did one every 2-3 years, my new one does them yearly. Ejection fraction is the percentage of blood pumped by the ventricles when they contract. The pacer can make the heart beat faster but it can't control how hard the heart muscles contract. Normal is an ejection fraction greater than 55%.

People vary but I've heard of people getting EF as low as 30's without noticing much difference in their stamina. I believe 30% is the cutoff for getting the third lead, but I'm not positive about that. First symptoms would be fatigue and easily getting short of breath. CHF (congestive heart failure) is when the muscles stiffen and don't contract as hard. The third lead doesn't really make it beat harder but what it does is pace both the left and right ventricles and force them to stay in sync. Sometimes this increases EF but it's not a guarantee. They do it in conjunction with meds that make the heart not beat as hard and beat slower in order to take the strain off the heart.  A CRT is not a cure-all for CHF and it can't prevent it, only help it. That's why I feel it would be overkill for either of us. 

There are a few doctors that do proactive CRT (3 lead pacers). I was offered one at my last replacement and turned it down. If the day comes I need it, I'll get it, but until then if it ain't broke, I don't see a reason to mess with something that is working for me.  My new doc was appalled that I was even offered it. He firmly believes only use as needed. They are more invasive to put in,  it's more hardware that can wear out. Infection risk is low, but the more invasive, the higher the risk. If you don't need it, it's just overkill. 

Seriously, do not stress over losing function. It's not that common. If it happens, there are fixes for it. Stress will shorten your life, save the worry for the big stuff. This truly is not the big stuff, imo. My electrical system is compromised so I do my best to make sure my arteries stay clear and my heart muscle stays strong. I don't want to compound the problems I already have with something preventable. Stay fit, eat  a heart healthy diet, keep up with your checkups. We are monitored better than our peers that don't have heart conditions so we have the advantage of early detection if something does start to go downhill. If it happens, we will know right away and can step in and treat it. 

You’ve helped so much!

by Debstinydogs - 2018-01-10 22:41:37

Tracey, again thank you!  You’ve have helped ease my fears so much!!!  While I have trust in my EP, he’s definitely not one to sit and answer a bunch of hypotheticals.  I will sleep much better tonight because of you!

Just curious, are you in the healthcare field?  You are certainly knowledgeable!

Debbie

nope

by Tracey_E - 2018-01-11 09:58:10

Not in the healthcare field, just insatiably curious and a bit obsessive about understanding how things work. I was diagnosed in 1971 so I've had a few years to read everything I can get my hands on and pester my doctors. I've been fortunate to have doctors and a SJM rep that get my need to understand what's going on and have been great about explaining things to me.