Biventricular Pacemaker

Third Lead

by Grateful Heart - 2018-03-25 10:16:05

Bi-Vent also known as a CRT (Cardiac Resynchronization Therapy Pacemaker (CRT-P) or CRT-D.  The D at the end instead of the P means with defibrillator and they both have 3 leads.  The third lead paces the left ventricle so that both ventricles pace in sync (instead of dancing out of step), sending more oxygenated blood out to the rest of your body and organs. 

Having the third lead should help increase your ejection fraction.  It did help mine (from 24% to 55%) but not everyone sees improvement as we are all different with different conditions.

I have a Boston Scientific too.  Search for CRT... on their site and you'll find other posts here about them too.

40 years?  I think you are the winner!!  (A prize none of us wanted lol).  I know a few here have been paced 30 something years.  Congrats!

Grateful Heart

Third Lead

by steppingstones - 2018-03-25 13:26:24

Thank you for the information and I will use it to further research the device. Your use of dance out of place was good description. I was told my heart is doing the hoola while trying to beat.  Yes, 40 years last November.

I have the Boston Scientific L301 and I have to say it has been the best up until they had to turn off the minute ventilation a few months ago due to a software issue and waiting for the fix.  I understand everyone with a pacemaker with this feature had to be turned off.  I hope the new device will have minute ventilation also, as it is much smoother reacting…..that being said – I said about the quirks of each.  This minute ventilation thing, well I can raise and lower my arm on the side my pacemaker resides and max out my heart rate (120).  I learned to under use that arm as necessary. I really like the Lattitude monitoring gives such a great sense of freedom. 

I have a hard time with accelerometers as my heart does not like the extra beats caused by any vibration.  I think it is from in the beginning (1977) with my first pacemaker and lasting for 16 years there were only one rate pacemakers so I was use to 72 beats a minute regardless. 

Bi-Vent

by The real Patch - 2018-03-26 14:31:05

I am by no means an expert, but I'm not sure a bi-ventricular device is going to benefit your situation. The theory behind a Bi-Vent or CRT is that when the two ventricles become asynchronous ( out of time) use of this device to put the two ventricles back in synch will improve the strength of the beats and improve the Ejection Fraction. However, only a small percentage of patients who have this device actually see an improvement. My EF has actually moved further into the domain of the toilet after changing to a CRT-D.

There are criteria they can follow which is a fair predictor of success with this device such as having a QRS delay of 150ms or greater, but even that is no guarantee, so you really need to talk with your Dr.

same boat

by dwelch - 2018-03-29 01:16:20

I am 30 years in, number 5 which I got last year is a boston scientific bi-ventrcal, my first three chamber.  Same issue low EF from decades with a pacer (can happen between 15-25 years but I guess we are lucky we pushed that so much further).    I am told that there is a 70% chance the pacer will improve the EF, i have not had my echo/results yet so will see.

Are you on original leads? Do you have "spare" (broken) ones?  I have one broken one so one issue was what if they cant fit a fourth lead on the left side?  Move everything over to the right side or tunnel a lead over (or remove the broke ones).  Fortunately there was room.  

What brand are your current leads?  There is an issue going on right now with boston scientific and other branded leads, requiring an adjustment or firmware update, not sure...So make sure you ask about that.  google boston scientific sensor glitch.  ask the doc about that as well as about room for the additional lead.

The problem is that the heart is supposed to be paced from the center with a wave going out hitting the muscles in a synchronized way.  But with pacing from the side, particularly on the ventrical you get this imbalanced wave, eventually the heart changes/reacts to this.  I think the older soltuion was to simply start pacing from the other side.  But with ICDs and such three and four chamber pacers/ICDs are now seasoned enough to be not experimental.  So the biventrcial you have a lead for each ventrical and ideally they try to get the timing such that each is fired from its own lead and at the same time...and not supposed to take 20-40 years to undo what has been done so far. 

Supposedly 6 months should tell, but my doc moved officies, the echo is not in the same group/place so I didnt get an echo at 6 months, so I have to wait another 6 to find out if it worked, am mostly over the anxiety now, but no doubt as the appt gets closer the anxiety will increase.

If you have broken leads, if extraction is desired/required, or tunneling, or whatever make sure you have a good surgeon.  Supposedly I had the best one in the area, fortunately it was a very routine procedure, no issues.

CRT-d

by Volunteerdr - 2018-03-31 09:37:54

i am a new crt-d with Boston Scientific.(3-27-18)  My ejection fraction is 30.  I could tell even coming out of or that I felt better.  I of course have some discomfort from the incision and shoulder pain but that was to be expected.  Also with the left lead have some twitching...I call them hiccups.  All are being worked on.  My bp is great and new energy!  Praying you also will have a good experience. 

Third Lead

by steppingstones - 2018-03-31 11:04:35

Thank you all for your comments as it helps me try to figure out things.  I still have not talked to my EP yet appointment is over a month away.  I learned of the diagnosis of CHF from the MY Charts for the hospital where the catheterization was completed.  My EF is at 40%.   Anyway, I have decided to travel to Duke for treatment.  My choices nearest UVA or Duke and I know Washington Univ in St Louis has great doctors as they have already saved my life once, but they are a thousand miles away.  I am not happy at the time it takes to get an appointment at Duke, but I will be persistent.  I have to get my records together and then I can hopefully work with getting an appointment sooner.  Any suggestions or recommendations on a doctor would be appreciated. 

I do have one set of old broken leads (1977 implant) and by xray they look like a birds nest in my shoulder.  So I don't know what that will do for the overall procedure. 

Thank you all again!!