Does Pacemaker weaken the heart

No, and perhaps

by crustyg - 2021-01-25 03:56:33

Having your heart's electrical activations driven by a PM doesn't 'weaken' the heart: let's leave aside the potential problem of long term RV-apical pacing and LV-remodelling.

Will your heart deteriorate over time?  It depends on what was the underlying mechanism that led to you needing a PM in the first place - SSS - because for many folk we don't have a full set of answers to that one.  Having more electrical activations isn't an issue: you aren't born with <x> million heart beats, so you need to avoid using them all at once!  The evidence for the positive effects of exercise (inc. higher HR) is massive.

And then there's Old Father Time. Despite your PM, time travels in a forward direction for you and everyone else.  Whether aging shows up as more heart issues, or something else is almost certainly unknowable - and you're probably doing all the right things to stay active, keep fit and eat sensibly.

Good health in our senior years (and you aren't there yet, I know) is 50% Good Living and 50% Good Luck: it's about as crude and simple as that.

Carpe diem and enjoy your healthy, active life.

Can a pacemaker weaken the heart ?

by Gemita - 2021-01-25 05:49:11

Steve, firstly let me say from the outset that if we need a pacemaker, we need a pacemaker and doing nothing would be far more harmful not only to our heart but to our health in general and affect our quality of life too.  You needed that pacemaker and so did I with sick sinus disease.  Looking at your very healthy imaging reports, you look to be in very good shape, just your electrics have developed faults.  

Can you expect problems down the road?  Well as we age anything can be expected.  Wear and tear occurs in other places too, not only in our hearts, but which can affect our hearts.  But you ask specifically:

Does a pacemaker weaken the heart ?  No, but the condition leading to the need for a pacemaker may weaken the heart.  For example I have AF with a rapid heart rate and this could lead to heart failure if it is not firmly controlled. 

On the one level, I see a pacemaker as a support system for the heart, to correct an electrical fault as in Sick Sinus syndrome or heart block.  With these conditions I can only see a pacemaker as a benefit because both these conditions can be helped if not completely fixed with a pacemaker.  Certainly as these conditions progress they are clearly not benign diseases in themselves which can easily be ignored.  For instance, I was out driving prior to my pacemaker implant and had a near accident due to pre-syncope as tachycardia/bradycardia symptoms hit.  Syncope was the main reason for my pacemaker due to Sick Sinus Syndrome.  Syncope can kill in the wrong place at the wrong time.  My husband similarly collapsed while on holiday in Italy due to heart block.  It was a frightening experience to witness and I had to support his head as he crashed to the ground.  It happened so suddenly, so quickly and I was relieved to be there to protect him.  But oh dear, I thought I had lost him.  But we may not always be so lucky, so we clearly needed that pacemaker.  On a second level we may need the support of a higher grade pacing system if heart failure symptoms should develop in the future from say structural heart disease (like valve disease/ischemic heart disease for example) and this might not be quite so easy to fix with a pacemaker as say a simple electrical fault.  

Your second question about concern that a higher level of pacing might increase the likelihood of weakening the heart is a valid one.  My main concern with a pacemaker is the potential to develop a loss of synchrony between the heart’s four chambers and then this leading over time to heart failure symptoms which may then need treating, perhaps even with an upgrade of our present pacing system to a cardiac resynchronization therapy pacemaker.  However surprisingly most of us never go on to develop this problem even after years of pacing.   Briefly, physiological synchrony of atria and ventricles are altered whenever a pacing device is implanted and could lead to dyssynchrony which effects both AV coordination and VV coordination commonly referred to as AV dyssynchrony and VV dyssynchrony.

AV dyssynchrony can result in mis-timed atrial contractions causing back pressure in venous circulation systems that causes congestion (peripheral and pulmonary) as well as loss of atrial contribution leading to decreased cardiac output.

VV dyssynchrony can result in mis-timing of contraction of opposing ventricular walls, as seen in right ventricular pacing causing left bundle branch block (LBBB) pattern. This could lead to a loss in output of the left ventricle and increases back pressure in the pulmonary circulation.

To understand how the heart works, I attach a link which might be helpful. It is short and simple to understand

https://www.bhf.org.uk/informationsupport/how-a-healthy-heart-works

But Steve, please do not worry about any of the above.  You asked the question, so I have attempted to answer as fully and as honestly as I can.  I will repeat, most patients never go on to develop problems from pacing and in fact live long, healthy and extremely productive lives.  I wish you well and hope you will come to terms with your device very soon and the questions and doubts will disappear as you begin to feel the benefits of a steady heart rate

What's your pacing mode?

by crustyg - 2021-01-25 07:34:08

Ideally, if you only have SSS then you'll be set to AAIR.  There is no logical rationale for ventricular pacing if you have a demonstrably working AV-node and just SSS (which will inevitably give you CI, for which you need the Rate Response - the R at the end of the pacing mode).

Then there's no concern about the possible effects of long-term pacing on an RV-apical lead.

We have the exact same model of PM: they tried using the clever-software RYTHMIQ(TM) mode on me, but it still managed to pace my RV 2% of the time: 2% too much IMHO, given that I have an RV-apical lead.  Now I'm AAIR and much happier.  Only time will tell if I develop AV-node problems.  I don't lie awake worrying about stuff like that...

THANK YOU TO THOSE THAT REPLIED!!!

by SteveV - 2021-01-25 11:01:31

To those that replied to my questions...

Thank you very very much for the super informative and helpful replies. You guys are amazing.!!! So glad I joined this club... I am trying really hard to accept and come to terms with my new reality and the support I am getting here is certainly helping.

Weaken the heart?

by AgentX86 - 2021-01-25 17:59:41

Absolutely not. We'll let me put it a little more crudely. Death doesn't strengthen your heart muscle.

Live well and have fun. You can't control where you are, only where you're going. Eventually we'll all meet at the same place but some will enjoy the trip and some won't. Your choice.