My wife has had 2 AVR's, 1st was from a ROSS and 2nd and final a St Jude MV, and no pacemaker.I am moderate AVS but am concerned about the need for a permanent pacemaker after AV Replacement. Is it a common occurrence or not. I will discuss this with my cardiologist
Basically two primary reasons for a pacemaker. The first and most common is when the normal pacer in the right atrium starts to punk out and the rate slows. A pacer is placed that signals the right atrium to contract and the signal is sent to the ventricles to contract when the normal rhythm drops below a preset number.
The second reason is when there is a disruption in the signal getting to the ventricles from the atrium. Some beats may get through (second degree block) or no beats get through ( third degree block).
Sugery around the aortic valve even TAVR can cause 3rd degree block.
Sometimes the ventricles will beat on their own without any signal at a very low rate say 20 beats/min. Other times they don’t beat at all without a signal.
I developed 3rd degree block after my third surgery which was replacing the aortic valve and repairing a aortic aneurysm. I had no intrinsic ventricular beat. Been paced for 14 years . And I am considered pacemaker dependent.
No pacer no life . Those with slow atrial rates are not pacemaker dependent.
To make matters a bit more complicated the usual routine is to pace the right ventricle and have the signal spread to the left. But having wires in both the right and left ventricles makes the heart more efficient. Generally biventricular
pacing is done for people in failure. It probably should be done for everyone who needs 100% pacing. I was not in failure but I convinced my electrophysiologist to add a left ventricular lead and place a biventricular pacer. Improved my cardiac output 20%.
I am asymptomatic - moderate AVS - although annual check in 3 weeks will tell me more.Even in asymptomatic patients if various tests suggest
Besides the tests you have mentioned, an echo stress test and transophageal echo (TEE) should also be performed.What other "various tests" should i ask for, I dont want irreversable change