Pacemaker Poll

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QuincyRunner

VR.org Supporter
Joined
Sep 22, 2015
Messages
34
Location
Tallahassee, Florida
Thought it would be interesting to ask if you had a pacemaker implanted following valve surgery? If so which valve do you have and how soon after your OHS was it determined that you needed a pacemaker? I am particularly interested because my cardiologist tells me that based on a recent EKG and follow-up with a heart monitoring device that I have intermittently shown signs of stage 3 heart block with my HR dropping to the low 30's. I have had no negative symptoms and my MV replacement surgery was 8 years ago. I am told that the atrioventricular conduction system is very close to the mitral valve and that the AV Node was probably negatively impacted. I have resisted calls to go to the emergency room because it doesn't make sense to me that I have been fine for 8 years and still feel fine. I guess my tombstone will read "Died from an acute case of stubbornness".
 

harrietW

Attitude of Gratitude
Joined
Oct 24, 2014
Messages
566
Location
Magrath, Alberta, Canada
QuincyRunner
Very interesting ..
I am 9 weeks post triple valve replacement this week. Second surgery first being Aortic mechanical mitral repair.
During my first week post surgery l was in complete heart block 4th stage. They gave me a blue wristband with a date that if it didn't correct itself they would proceed with the pacemaker. I went from 4th stage to first stage, stayed in first stage for a few days eventually straighten itself out however I've been having trouble the last two or three weeks with almost passing out followed by dry heaves the worst event being last Thursday. These events seem to be progressing. Today and half of yesterday I wore a heart monitor which there was really no events nothing significant anyways. I know I'm having some issues and I do believe I'm in some sort of heart block and I think possibly only first stage. I just recently had a an echo that showed diastolic dysfunction. This is where I think the problem is for me. I see cardiologist again next week. I'm interested to see what she thinks about these almost passed out stages with nausea followed by dry heaves, back pain and chest pressure. My understanding is you can be asymptomatic. Not 100% sure yet what the issue is but hope to figure it out soon. I honestly don't think I want a pacemaker. I know several people with them some love them others feel on guard all the time.

Best of luck. It's not an easy decision l wouldn't think !
 

Enigmalady777

Active member
Joined
Mar 27, 2018
Messages
26
Location
Santa Clarita, CA
I had a Pacemaker/Defibrillator implanted this past June, 15 months after my OHS for mitral valve replacement with a St. Jude's mechanical valve. I went back into congestive heart failure around March of this year almost exactly one year to the date of my surgery last year. My heart rhythm and pulse went out of whack in December of last year.

Now I've had Afib for many years, (unrelated to the valve problem) but it just went bonkers starting in December of last year and continued until my Defibrillator/Pacemaker implant and a cardio version were done this past June. I was in a cardiac rehab session which is an exercise program where you're monitored with a holder monitor as you exercise (I was going two days a week and the rest of the days I was going to my regular gym) and the nurses made me stop and sent me to the ER.

I was told during the ER visit that I had a "bundle block" but wasn't told the stage. I wasn't supposed to be exercising before the implant surgery, but I did cheat and exercise, but I really couldn't physically do it with the same intensity or for the same length as before the CHS set in.

So far I'm good and I am hoping I will be able to stay healthy a long time (fingers crossed), and won't go out of rhythm or have a high pulse rate again, but there are no guarantees, obviously. I was able to get back to exercising at the gym with the same intensity as before the CHS pretty quickly after the implant. I am back to going five days a week.

I do have to say -- I feel SO MUCH BETTER after the implant!!! I was worried about having the Defibrillator/Pacemaker (afraid of the potential shocks the device can deliver if an abnormal heart rhythm is detected) implanted but so far, all is well.

Were the valve replacement and the wonky heart rhythm related? I have no idea. Interestingly enough, I had a carioversion done 4 years ago for the Afib and it didn't work in resetting the heart rhythm. Why it worked this time is still a mystery, even my cardiologist couldn't tell me.
 

gerrychuck

Well-known member
Joined
Nov 17, 2012
Messages
179
Location
Moose Jaw, SK, Canada
Had mechanical mitral valve replacement 7 years ago, with paroxysmal AFib after. AFib has increased to being pretty much persistent, and a left bundle branch block started showing up, leading to some bradycardia issues (asymptomatic). Pacemaker implanted 1 1/2 years ago. Currently paced at about 68%. EF has dropped some since; may be due to increased cardiac asynchrony due to the right ventricle pacing. Waiting right now to see a focused cardio team to sort through everything. I'd like to get biventricular pacing, but I don't meet the criteria used here at this point (my EF hasn't dropped low enough). In the meantime, I feel fine and exercise 5 day/week. My dose of ace inhibitor and metoprolol has been increased significantly too, so I'm hoping my EF is back up to 50 or so in any case.
 

bobr33543

Member
Joined
Jun 26, 2015
Messages
10
Location
Tampa, FL
I had standard AVR done 7.5 years ago. The surgery was botched and redone 4 weeks later. Three days after the second surgery it was determined necessary to have a pacemaker installed due to no conduction between upper and lower chambers. They used a St. Jude (now Abbott) pacemaker with no defibrillator.

So I have more than seven years of relying on a pacemaker to stay alive. I think this qualifies me to have an opinion.
1) It keeps your heart beating when your own heart's conduction system fails (obviously).
2) It does not correct arrhythmias, but it monitors your heart's electrical functions and alerts your cardiologist if it detects serious issues such as A-fib and A-flutter. I recently developed A-flutter and I could easily tell when I was having the issue by my resting heart rate (the pacer is set for 60 BPM under normal conditions, 70 when arrhythmias are detected).
3) The surgery and recuperation is a piece of cake, nothing to fear.
4) My pacer model had a life expectancy of 7 - 10 years, newer ones may be longer.
5) The only downside on my model (and leads) is that I cannot have an MRI and I should avoid metal detection security devices. I also recently found out that I cannot use a TENS machine. Many newer models and lead systems do not have these issues.

Conclusion: I love my pacemaker!
 

DanielB

Well-known member
Joined
Dec 13, 2010
Messages
250
Location
San Diego, CA, USA
I had my Aortic valve replace in in October 2011 and started feeling odd when walking up steep hills the following march. I described like trying to go up a hill starting in third gear. The doctors completely misdiagnosed it and, a month later while having a treadmill stress test, they discovered the heart block. In the month that followed, my resting heart rate dropped to 38 and, with the concern about light headedness (I had none) I had a pacemaker implanted in July of that year. Procedure was easy and my resting heart rate is its normal 70. I am told my heart now determines the pace, but the pacer take the signal and gets it to my lower chamber in the time needed. In any case, it has been a good experience. I had a St Jude pacer installed and I cannot have an MRI -- that's the main drawback. I have heard on new ones that are MRI compatible, I would ask about that. No issues with security screening. I have been told it is okay with my pacer to go through metal doctors, but I still have them hand wand me to be safe,

Good luck on yours .
 

vitdoc

Well-known member
Joined
Apr 16, 2017
Messages
65
Location
Southern Ca.
I developed complete (3rd degree) heart block after my third open heart in 2006. The surgery was for a aortic aneurysm with the aortic valve redone also. Basically the sinus rhythm generated in the right atrium could not reach the ventricles. Some people have an intrinsic ventricular rhythm that is slow around 20-30 which would keep you alive without the normal signal. Some have very slow or no intrinsic ventricular rhythm so if the signal to contract doesn't reach the ventricle you die.
I have no intrinsic ventricular rhythm so I am 100% pacemaker dependent.
Normally a lead is placed in the right ventricle and the electric signal spreads from the right to the left ventricle. This gives a somewhat asynchronous beating between the right and left ventricle.
So another ventricular lead can be placed in the coronary sinus which is basically a large vein in the left ventricle. It is more difficult to place than the standard right lead. So generally in the US electrophysiologists place them rather than routine cardiologists.
The pacers are connected to the two leads and can be set to make the right and left ventricle work together better. Probably FOR EVERYONE especially those who are chronically paced they should have biventricular pacing. There even is an entity observed where there is a sort of cardiomyopathy from chronic right pacing only.
I initially had just right ventricular pacing but my cardiac output started to decline although it was never very low. 55%-45%. I spoke with my electrophysiologist and we agreed to place a biventricular pacer in 2012. My cardiac output went back up to about 55%.
I had the pacer for about 7 years and just earlier this year had my second placed due to a battery issue.
So try to get a biventricular pacer. In places like Canada they have certain criteria such as going into significant heart failure before they will place a biventricular pacer. They are a bit more expensive and require more skill for placement of the left lead. But I feel strongly that they should be used more. One of the few advantages of non government health care is a bit more flexibility. (although insurance companies try to control things also).
Also as far as MRI compatibility goes: There was an article out of Scripps hospital in San Diego last year or so with over 1700 cases of non officially MRI compatible pacer patients having MRIs without any problems. I had one for a ruptured disk with my old non MRI certified pacer.
Only a few places are doing these due to issues of liability. I had my MRI at UCLA. NO PROBLEMS.
 
Last edited:

gerrychuck

Well-known member
Joined
Nov 17, 2012
Messages
179
Location
Moose Jaw, SK, Canada
I developed complete (3rd degree) heart block after my third open heart in 2006. The surgery was for a aortic aneurysm with the aortic valve redone also. Basically the sinus rhythm generated in the right atrium could not reach the ventricles. Some people have an intrinsic ventricular rhythm that is slow around 20-30 which would keep you alive without the normal signal. Some have very slow or no intrinsic ventricular rhythm so if the signal to contract doesn't reach the ventricle you die.
I have no intrinsic ventricular rhythm so I am 100% pacemaker dependent.
Normally a lead is placed in the right ventricle and the electric signal spreads from the right to the left ventricle. This gives a somewhat asynchronous beating between the right and left ventricle.
So another ventricular lead can be placed in the coronary sinus which is basically a large vein in the left ventricle. It is more difficult to place than the standard right lead. So generally in the US electrophysiologists place them rather than routine cardiologists.
The pacers are connected to the two leads and can be set to make the right and left ventricle work together better. Probably FOR EVERYONE especially those who are chronically paced they should have biventricular pacing. There even is an entity observed where there is a sort of cardiomyopathy from chronic right pacing only.
I initially had just right ventricular pacing but my cardiac output started to decline although it was never very low. 55%-45%. I spoke with my electrophysiologist and we agreed to place a biventricular pacer in 2012. My cardiac output went back up to about 55%.
I had the pacer for about 7 years and just earlier this year had my second placed due to a battery issue.
So try to get a biventricular pacer. In places like Canada they have certain criteria such as going into significant heart failure before they will place a biventricular pacer. They are a bit more expensive and require more skill for placement of the left lead. But I feel strongly that they should be used more. One of the few advantages of non government health care is a bit more flexibility. (although insurance companies try to control things also).
Also as far as MRI compatibility goes: There was an article out of Scripps hospital in San Diego last year or so with over 1700 cases of non officially MRI compatible pacer patients having MRIs without any problems. I had one for a ruptured disk with my old non MRI certified pacer.
Only a few places are doing these due to issues of liability. I had my MRI at UCLA. NO PROBLEMS.
Yup. My EF dropped from roughly 50 to 40 with the pacer, but the criteria here in Saskatchewan ( Canada) for going to biventricular is it has to go below 30, and then they go with a defibrillator as well because of the risk of arrest at those EF levels. I'm not impressed. If the biventricular unit was used earlier, there would be no need for the defibrillator and it would avoid the cardiomyopathy you mentioned. Sigh.
 
Last edited:

Debster

Well-known member
Joined
Jul 8, 2005
Messages
549
Location
Louisburg, Kansas
My mom had a biventricular pacer put in a year and a half after her mitral replacement/bypass surgery. They also had implanted a defribrillator as well-but at her last battery replacement they removed it because she had zero shocks in over a decade. I think this pacemaker has helped her tremendously as her EF is in the normal range now. Before her surgery it was in the 20s :(
 

QuincyRunner

VR.org Supporter
Joined
Sep 22, 2015
Messages
34
Location
Tallahassee, Florida
Thanks to everyone who responded with their thoughts and experiences. There is a lot to consider but this will help me prepare with more questions when I finally meet with an EP Doc next Tuesday. My regular cardiologist finally stopped the heart rate monitoring because the on-call docs were tired of getting calls from the heart monitoring company in the middle of the night and I was refusing to go to the ER anyway. However, I have been monitoring my own heart rate and have seen no big dips in HR. Plus I have still been feeling great. The EP Doc will have to be very convincing for me to submit to the pacer.
 

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