Biventricular Pacing

V SR

by Terry - 2022-04-24 13:05:15

Up-to-date doctors who used to do biventricular pacing, now use one lead at a site called the His bundle (Google that). Or, take a look at <His-Pacing News – His-Pacing.org>.

No, you no longer need to go to Mayo, Cleveland Clinic or a university hospital for normal, physiologic ventricular activation.

Terry

Fibre-optic trans-pericardial LV pacing wire

by crustyg - 2022-04-24 16:28:24

These days if they can't get an LV pacing wire into the coronary sinus and down towards the LV they can go for a minimally invasive extra-pericardial approach and get a pacing wire to the LV that way.  They tunnel the 3rd wire up to the device pocket and you're good to go.

"Angry that they say my heart is remodelling after Mi and quad bypass 16 years ago and yet they want to kill of [sic] a healthy bit of my heart."  Remember that Anger only burns yourself.

There are a few contributors here who've had an elective AV-node ablation.  Call it 'kill...healthy..heart' or a deliberate decision to prevent further damage from AFib - it's your choice.

Biventricular pacemaker and HIS pacing

by AgentX86 - 2022-04-24 16:40:39

I han an AV ablation four years ago and haven't been more pleased with the results.  I was putting it off, trying every other alternative to lessen the symptoms of my flutter.  I wasn't sleeping so couldn't function. I then developed long asystols so needed a pacemaker anyway.  The AV ablation wasn't such a big step, at that point.

After the ablation I no longer had the (horrible) symptoms and could sleep again. I have classical CRT pacing which I HIGHLY RECOMMEND in this situation. After the AV ablation you will be pacemaker dependent with a very good chance that you won't have an escape rhythm.  Often (alsays?) the bundle of  His is also ablated, making His pacing moot.

A single ventricular lead leaves you wide open to a lead failure.  You will be dependent on your pacemaker, which is bad enough, but you will also be dependent on a single lead. It's exceedingly rare that a pacemaker fails completely but it's not uncommon for a lead to fail (though usually not catastrophically). You're then up sheets creek, in need of some paddles, as is goes.

Discuss this with your EP.  I'd be surprised if they'd consider His pacing after an AV ablation.

Backup

by Terry - 2022-04-24 19:42:01

Good point, AgentX86. Back when His bundle pacing was new, doctors used to connect a backup lead, just incase.  Of course, with the secure fixation in the central fibrous body, a backup is often provided via non-specific His pacing. Myocardium is stimulated along with the His bundle. Yet, the high conduction velocity of the His/Purkinjy system, terminating in hundreds of ventricular locations to choreographing the ventricular activation, His dominates over the slow conducting myocardial stimulation.

Terry

His bundle pacing

by JaneJ - 2022-04-27 00:13:45

I had a his bundle pacemaker placed after I fractured my ventricular lead a few years ago.  I went to a medical center that was at the top of their field with his bundle pacing. At my 4 week check up it was found that my his bundle thresholds were extremely high and in fact, not even capturing occasionally.  Several years before all this I had an ablation for junctional tachycardia and they ablated more than the av node than I thought, rendering me fairly dependent on my pacemaker.  Needless to say the his bundle pacemaker lead had to be pulled and they replaced it with a biventricular.  I'm not even sure how they qualified me for a biventricular because I do not have heart failure or cardiomyopathy.  Good luck with whatever you decide to go with!