Left ventricle pacing

LVEF

by DAVID H - 2018-07-14 13:58:06

Your LVEF is the same as mine. I have a Medtronic VIVA XT CRT-D. The defibbrilation aspect of this PM is to guard against sudden cardiac arrest - a threat to those with a low LVEF.  The only thing in the past that I've found to improve the LVEF is a cardiologist whose specialty is echocardiography and can "read" an echo. A pacemaker optimization is what you need.

--Dave--

pacemaker optimization

by DAVID H - 2018-07-14 14:55:59

An echocardiography Doc I had seen a couple years ago prided himself in regards to his ability to "read" an echo.  His sonographer - a guy named Chris - was almost as talented as he.  The Doc studied to sonogram, and instructed the device nurse to do this, then that, then the other thing. After 10 min. of instructions, the Doc gave one more to the nurse. Immediately, both the Doc and the Sonographer shouted, "ALL RIGHT!" at the same instant.  I felt just fine afterwards. Unfortunately, he retired a few months ago. How does one find a competent replacement? Anyone out there know of a talented Echocardiography Doc?  BTW: The only Doc I've found in the Mayo system that performs echo guided PM optimizations is Dr. Tazneem Naqvi who is in Phoenix, AZ.

--Dave--

Some doctors...

by AgentX86 - 2018-07-14 19:43:58

The whole purpose of CRT pacemakers is to improve LVEF.  Unless you have damage to the LV that is irreparable, I can't imagine them recommending against a CRT (whether or not you need a defibrillator is another discussion - no information in your post).  IMO, LV-only pacing is a dinosaur.

Viability test

by Imtiazjanjua - 2018-07-15 11:44:26

Doctor recommended me to have viability test to check how much heart muscles are damaged, after that final decision will be made about what procedure to follow.

Echo report

by Imtiazjanjua - 2018-07-15 11:51:44

I have uploaded my latest echo report in gallery.

wow

by The real Patch - 2018-07-16 12:33:38

so many questions and no reasonable answers.

Okay so first out of the chute, they are recommending the defibrillator function due to your low Ejection Fraction of 20%. In fact any EF of 30% or lower is considered an automatic trigger to implant a defibrillator. The low EF makes you prone to SCA and other deadly issues. The defibrillator function is a safety feature for you. Most people who have a defibrillator never get full therapy, the infamous Jesus Jolt. But if you need it, you'll be thankful it's there.

As for a Left Ventricle pacing...they really don't do that. If you need pacing for LV issues they pace the right ventricle.

The name CRT (Cardiac Resynchronization Therapy) defines exactly what the device is designed for, and it ain't for the left ventricle. When you have Bundle Branch Block, on either side, the ventricles are beating out of time with each other and as a result the beats are not as strong as needed to properly eject blood into the body. By pacing you in both ventricles as close to 100% as possible, they can force the ventricles to beat in sync and increase the output. They have found this to be most effective when your QRS width is greater than 50ms. If your QRS is narrow (ie the beats are close together) the device is not likely to be beneficial. It should be noted that if you are paced 100% that does not make you pacemaker dependent. If your heart will beat without a pacemaker, you are not pacemaker dependent.

I should also note, the earlier models of CRT were called Bi-Ventricular devices, and some manufacturers still use the term. It's the exact same thing.

In closing let me add, I read a medical  study which showed nearly 50% of the CRT's are being implanted unnecessarily and the patients do not meet the criteria identified by the medical community.

I have a CRT-D, met all the criteria and in theory everything said I should benefit, but my mitral valve stenosis and prolapse are too severe so I see not difference with this device after 2.5 years.