6 months post-op and time for a CRT (biventricular) pacemaker

[realkarl]

I am posting in the post-surgery forum, since my upcoming PM implant on Monday 1/11 is really a follow-up to my valve replacement surgery.

A remaining problem after my valve replacement and repair surgery has been what is called a Left Bundle Branch Block. This means that the electrical signal from the heart's sinus node is delayed on the way to the left ventricle, which again means that it beats later and out of sync with the right ventricle. The cause for the LBBB is uncertain, it could be the radiation that damaged my valves, or the LV expansion that happened before my diagnosis and start of CHF medication.

This lowers the heart's efficiency, with the result being that no matter how much or hard I exercise, I can not get back to my pre-surgery aerobic capacity and outdoor activities, and I even have trouble with several floors of normal stair climbing. To not even get back to my pre-surgery state has been a source of frustration and disappointment for me. After all, the goal of the surgery was to make me better, not worse. I am of course better in the sense that the valve leaks are fixed, and they needed fixing sooner or later, but worse off in what I can do activity wise, and that's been hard to accept.

Fortunately there's technology that can help with a potential for significant improvement for cases just like mine. So I will have a CRT *) pacemaker implanted, that listens to the heart's sinus rhythm and makes sure those signals get transmitted to the right and left ventricle at the exact same time. This is different from normal pacemakers which are used when the sinus node is not functioning well or there are other blockages or electrical disturbances, and the heart ends up beating to slow (bradycardia) or too fast or fluttering (atrial fibrillation)

(CRT= Cardiac Resynchronization Therapy, a.k.a. binventricular PM)

The technology is pretty advanced, which I am very glad I was able to choose . Every night my tiny St Jude PM will transmit the day's data (heart rate, voltages, missed beats etc) to a home station wirelessly (Merlin @ home). The station then dials up a server and transmits the data for analysis. If a problem shows up, my doctor will be alerted as soon as possible. Older PMs require a doctor visit and a reading via a magnetic wand every few months. Sadly, this new and advanced home station requires a phone landline (talk about mix of old and new technology ), which like many others, I don't have. I will see if I can figure out a VoIP solution that can handle the analog transmission.

The procedure is most likely out-patient, home same day, I'll be awake while they thread the three leads to the right places in my heart, before they make a little pocket under my left clavicle and superglue (yes, indeed) the device in place..

Karl.

 

[escargome]

Good Luck and best wishes on the upcoming implatation of pacemaker. I hope all goes well and you are soon up to at least your pre-surgery activity level.
Hey on the phone line subject, maybe if you speak with a rep. from the local provider they can give you a break on cost so that all you truly pay for is the ability to transmit your health data. It seems a long shot but may be worth a try. Again I will keep you in my thoughts and prayers

 

[mainframe]

I have a right bundle branch block. The Cardio said it was no big deal but it seems Dr. Miller implanted a pacemaker during my surgery. I'm still ticking away.

 

[RonP]

Best of luck on your procedure! I'm following your progress closely. I'm at 3 months post-op for mitral valve repair and carefully watching my EF. At one month I was at 25-28%. I just had another echo and the doc thinks it's now in the low 30%'s. I feel fine and wouldn't know that there's a problem but...if it doesn't improve to over 35% I'll have a pacemaker in my future, too. My doc wants to wait 9 months before making the decision to see if my heart improves with increased carvedilol, linsinopril, and digoxin. Keep us up-to-date on your progress. Good luck!

As an aside, when I had my echo I was watching the monitor and saw that the computed EF was 41%. The tech said that the doctor had to review it and would make the final determination. She repeatedly commented to me that she "didn't tell me the number" and that "the final number may not be the same." I had my hopes up but when the doc called he said "low 30s". Don't know why or how he felt it was lower, but...

Ron

 

[Debster]

Hey Karl! Good luck Monday...I think I have pm'd you before about my mom...she also had LBBB. I know this puppy (bi-vent) will help you mucho...can't wait to see your posts in just a few months Keep us posted! Deb

 

[Kathleen]

Had my second bivent implanted 4 weeks ago along with a new lead. Understood everything you wrote. Needing mine 99.9% of the time. Hope you do well and achieve a higher EF. They are utterly awesome units. I had the Concerto this time. Good luck and do absolutely keep that left arm close to you no matter how good you feel.
Kathleen

 

[realkarl]

Best of luck on your procedure! I'm following your progress closely. I'm at 3 months post-op for mitral valve repair and carefully watching my EF. At one month I was at 25-28%. I just had another echo and the doc thinks it's now in the low 30%'s. I feel fine and wouldn't know that there's a problem but...if it doesn't improve to over 35% I'll have a pacemaker in my future, too. My doc wants to wait 9 months before making the decision to see if my heart improves with increased carvedilol, linsinopril, and digoxin. Keep us up-to-date on your progress. Good luck!

The estimated EF from my echo cardiograms has been stuck at around 40% since surgery (and even before), and upping the medicines you mention back up to the same dose as before surgery has not helped. Even at this relatively high EF, but much lower than normal, it affects my exercise ability significantly, and is probably also the cause for increased pulmonary hypertension. So my cardio/EP thinks I would benefit greatly, even though I am above the "magic" 35% threshold.

As an aside, when I had my echo I was watching the monitor and saw that the computed EF was 41%. The tech said that the doctor had to review it and would make the final determination. She repeatedly commented to me that she "didn't tell me the number" and that "the final number may not be the same." I had my hopes up but when the doc called he said "low 30s". Don't know why or how he felt it was lower, but...

Yeah, I am annoyed I can't learn anything from the techs until the cardio has reviewed the echo, and it can take up to a week for me. I have been told that especially due to the ventricle dyssynchronicity the computed EF from an echo can be very different from the actual EF. Your doctor probably estimated your actual EF by visual examination.

I was sent to do a radionuclide ventrculogram to measure EF accurately. It achieves this with a radioactive material being added to the blood and 3D imaging to measure the exact volume difference between max and min ventricle size. My cardio/EP wanted this, because if EF was below 35% the recommended device is a CRT-D, that is a CRT PM with a built-in defibrillator, because there is a higher risk for a-fib. at EF < 35%. It turned out my accurate EF is 43%, just a little over the computed EF = 41% at the latest echocardiogram, so I will get a CRT-P (no defib). This has a few advantages, size, battery life, no risk for accidental shocks.

Karl.

 

[realkarl]

Kathleen and Deb: thanks for the encouragement! The reminder to keep my left arm close is a good one - I shall try my very best. Don't want to tear out those carefully placed leads, especially the left one. I hope I am not among the 10% where it's impossible to place this without (minor) surgery.

 

[realkarl]

Everything went well, except a side switch...

Everything went well, except a side switch...

Compared to my OHS six months ago, this was indeed a piece of cake, as mainframe suggested it would be. The only complication was that my cardio/EP was not able to thread any leads from the left side, the usual vein was blocked. He said it could be yet another radiation complication.

However, from the right side, all leads were placed with great results, even the notoriously difficult LV lead. I am right handed, so we shall see if this causes any additional inconveniences. I asked how frequently this happened, and the nurse who was still in the EP room said it had happened only once before in the year she had worked there.

The side switch also caused it to take almost 4 hours instead of the usual 1.5 - 2, but here I am, back home the same day, with no stitches or bandages, only superglue, a new St, Jude Anthem RF CRT-P pacemaker, with the Left Bundle Branch Block fixed, with the QRS duration (LV contraction delay) set to 120ms, instead of the 160-180ms it was with the LBBB. I already feel stronger and more energetic, but I am sure that's just because I am so happy right now

 

[jax]

Karl:

Glad everything went well. I had my pacemaker implanted 5 days after my ohs. And I also recall feeling much better right after. I was in complete heart block and was still very short of breath and exhausted. After they put my pacemaker in I could breathe again easily. And felt much better. I still remember the hubby saying there's my wife. Full of p*$$ and vinegar. That was the first time after surgery that I started to feel alittle better. And the hubby was right I was full of it. So I don't doubt for one second that you already feel better. Keep it up karl.