Mitral Prolapse

Hello all. 

I wanted to pass along what I think is very important information to consider when getting a pacemaker. Apparently the primary way doctors attach leads for dual chamber pacemakers and/or ICDs can, in some patients, cause mitral prolapse or mitral regurgitation. This is significant because if you’re one of them, you will begin exhibiting signs of heart failure.

i began researching this because over the past two weeks my breath has diminished and seems to be getting worse only 5 months into this confounded device. I am a very fit 57-year-old who has never had breathing issues  

Aparently the dominant way of attaching leads nowadays is known as Right Ventricular Apical pacing (RVAP) I couldn’t tell you where this method attaches leads to the heart. I’m not a doc. But in some, this will cause an exaggeration of any mitral valve prolapse or even create a prolapse where there wasn’t one before. Most people live with some mitral regurgitation. 

The mitral valve receives oxegenated blood from lungs and left atrium before it is delivered to the big pumping chamber — left ventricle. A prolapse means that instead of moving forward during the big ventricle push, some blood squirts back into the atrium through the the prolapsed valve. I suppose the backward pressure is what creates the shortness of breath. 

The good news is that there is another way of attaching leads, maybe a bit new for some docs. That method is known as Right Ventricular Outflow Tract pacing. Again, I couldn’t tell you where the leads are placed. But it avoids that problem. There is an enhanced skill and lead manipulation required, from what I read.

if you are wondering how your leads were placed, I just called the support line at the PM manufacture and they were able to tell me how mine were. Doctors are required to report that. 

Im still working through my issue. If you want to research articles, just Google “Pacemaker-induced mitral regurgitation.”

 

4 Comments

Question

by BarbD - 2018-10-13 09:41:52

If the mitral valve is between the left atrium and left ventricle, how does the right venticle lead affect it?  Wouldn't that be the tricuspid valve between the right atrium and right ventricle?

How does MV prolapse happen

by Keithwhelpley - 2018-10-13 11:33:24

Barb D, I wondered that too. But apparently it does. The Mitral is a bicuspid. I wonder if this very question is the reason many docs haven’t caught onto it.  

My situation seems unusual to my docs because while everyone who has a properly functioning PM is able to get on with life, mine is actually making my life worse. I fired my last dock after he said it was in my head. It’s not! 

Five years ago my MV was measured as having mild to moderate regurgitation — long before my PM. Since then I have actively swum and cycled without a hint of a breathing problem. Question now is why 5 months after my PM does my MV exhibit symptoms of a worse problem. 

5 years ago my whole heart was measured and tested for an aortic valve replacement to repair a birth defect. Whalen that valve finally went south, it went fast. So my point is, I know valves can go fast. But I’m not convinced that is the case here. The will check my PM first before I’m talked into a MV surgery 

I am new but can give you some insight on the Mitral valve

by benne81 - 2018-10-19 12:57:41

I had severe mital valve prolapse without symptoms having gone from moderate-severe from my last checkup to severe after a year. was born with prolapse currently 27 and for years it always stayed the same only big change was becoming moderate. I had to get repair surgery this year because when its severe even if you have no symptoms surgery is the best option. and wound up with complete heart block a week after needing a pacemaker for braychardia I will say that if you have Mitral valve prolapse there may be no change for years or just mild change but it can happen suddenly even if you experaince no symptoms over time the gap of the valve in my case that did not close all the way can widen quite a bit. I have before and after pics and the hole was pretty big. I don't know your situation but talk to your cardiologist. 

I don't know exactly how they impanted my device but they knew that I had the repair surgery.

Mitral valve

by Keithwhelpley - 2018-10-21 18:50:24

Benne81, I wish I could speak intelligently about your situation, but I can’t. I am going in for a nuke stress test in two days.  I got my pacemaker in February as the result of a sick sinus syndrome diagnosis. Turns out I don’t have sss. Bad diagnosis. I still have a PM/ICD. 

In my case a new set of docs (I fired the last set) want to see how badly my mitral regurgitation is and other things. Five years ago it was tested at mild to moderate. Has it gotten worse and why, if it has. 

I’m reading a lot, which was the reason for my initial post. I think it’s always best to start Googling and reading. If you come across a medical article that may relate to your situation, try to find corroborating articles. 

Dont let what you read on this blog keep you from ansking questions. I’ve read here numerous times that the electrical conduction of the heart is separate from structural or plumbing. But that simply isn’t true. As I indicated above, pacing can induce mitral regurgitation, which would appear to be a structural issue and not electrical. So I wonder what else pacing can induce. 

One other thing pacemakers can induce is AFib or AFlutter, which I’m experiencing a bit lately. I’m discovering too that problems induced by PM don’t always happen right away. The mitral issue can begin showing 5 months after the implantation and symptoms can seem like it’s not the PM at all, but something else. 

One other thing is when people tell me that a pacemaker just sits there and only works when you need it — even doctors say that — it doesn’t seem to be true. An ICD works like that. In my limited experience, a PM functions more like a governor, especially on the low pulse side — giving you more pulse when it thinks you need it. But, then again, I could be all wrong regarding that. Maybe what I’m.  feeling is a mitral valve deviation as a result of my pacemaker. 

The big takeaway is that everything in the heart is interrelated. The human heart is an amazing thing. It refuses to live in a silo, as much as docs wish it would. It wants to do good by us. We can do good by it by going to a heart institute where cardiologists of every specialty are looking at it. I was given my pacemaker by a lone cardiologist reading data. He never tested for or saw a mitral problem. That this new set of doctors discovered. I may be naive, but just maybe they will find I don’t need this PM at all. I just need a mitral valve surgery — and I’d take that over a pacemaker all day long. All the best. You know your heart better than anyone. :) 

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