pacemaker and hypertrophic cardiomyopathy

hypertrophic cardiomyopathy

by AgentX86 - 2022-02-22 23:40:48

"Lower ventricle"?  Do you mean "left ventricle"? 

Yes, that's standard treatment for cardiomyopathy.  It's called "Cardiac Rehabilitation Therapy" or CRT.  A CRT pacemaker (CRT-P) or ICD  (CRT-D) has two ventricular leads, one in hach the right and left ventricle (sorta). The CRT-P is also know as a "bi-ventricular pacemaker". The idea is to pace the heart in a more normal way.

hypertrophic cardiomyopatthy

by bayla - 2022-02-23 00:50:09

Thanks for commenting. I mean right lower ventricle. Doctor want to pace 100% in right lower venticle.

RV lead placement

by AgentX86 - 2022-02-23 01:45:45

That's the normal place for the RV lead, in the RV apex. Are you paced now?

I'm surprised they're doing RV apical pacing for cardiomyopathy and not CRT or His pacing.

Nomenclature issue, perhaps?

by crustyg - 2022-02-23 05:50:12

Folk usually reserve Hypertrophic Cardiomyopathy for the condition (now known to be genetic) where the heart muscle becomes abnormally thickened and eventually outstrips its blood supply leading to VF/SCA/death.  Used to be called Hypertrophic Obstructive Cardiomyopathy (HOCM) as the outflow tracts can be restricted, but that's not the root cause of the condition.  Standard treatment is currently an ICD.  Different to Dilated Cardiomyopathy (also has a strong genetic basis but less well understood than HCM at the genetic level).  Genetic testing for these two conditions is fraught with difficulties and some testing centres will miss diagnoses.  Most patients with true HCM don't make it to your age.

Left-ventricular remodelling due to long-term pacing of the LV via an apical RV lead is an acquired condition that *some* long-term paced PM patients develop.  It's not clear who, why or when, and, as Agent correctly says, the current treatment is Cardiac Resynchronisation Therapy where a pacing lead is threaded through the coronary sinus (on the R side of the heart, just above the tricuspid valve) and gently worked down until the tip of the lead is in contact with LV muscle, so restoring a more normal pacing.  Usually effective at restoring %LVEF, but again, not certain by how much, or over what time this recovery will take place.

Given your implant year states 2022 my guess is that you're asking on behalf of someone else, or perhaps have misunderstood something?

Hypertrophic cardiomyopathy and 100% pacing

by bayla - 2022-02-23 22:34:05

Thanks for commenting. I just got the pacemaker 4 weeks ago, and was told by doctor because of hypertrophic cardiomyopathy, I hould be paced 100% on bottom.I don't know what that means, and I'm scared I'm going to feel worse. I'm getting used to what I have, and I don't want to feel worse.

New pacemaker

by AgentX86 - 2022-02-23 23:02:12

There is no reason that you shoud feel any worse and a good possibility that you'll feel a great deal better. It might take some tweaking but have some patience.  Make sure you let your EP and device tech how you feel and keep on them until they do the best they can.  How you feel is the metric that you should use.  They may not say they can do better but it's your life. Keep on them until you are satisfied that they really have done everything possible.

Hypertrophic Cardiomyopathy and pacing.

by Selwyn - 2022-02-24 10:40:10

Hi Bayla,

There is some evidence that pacing both ventricles with DDD set up and  a slightly longer A-V node delay can help slow the progression of hypertrophic cardiomyopathy ( 1/3rd  are  obstructive and then this is taken seriously). It may also reverse some of the changes! This is usually done if medical treatment is proving difficult.

I am holding this option in reserve!

See : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209435/

This is now a standard treatment option if there is obstruction to the outflow tract and medical treatment is not beneficial. 

 This is nothing to do with resynchronisation therapy ( CRT). The understanding is that the delay in ventricular contraction gives the ventricles an increased time to fill, given the poor compliance of the thickened ventricle muscle.

[By all means send me a private message if you want to discuss this further as I was at the hospital clinic this morning for my hypertrophic cardiomyopathy.]. 

hypertrophic cardiomyopathy and pacing

by bayla - 2022-02-27 01:29:04

Hi  Selwyn,

Thanks for commenting. You mentioned you were in the hospital for hypertrophic cardiomyopathy. Why do you have to be in the hospital? Are you being 100% paced for your myopathy? 

My doctor is pushng it, and Ifeel ok the way I am, the way they sent me home from the hospital. I don't know what to do.I do have the obstructive kind.

Thanks, Bayla