Pacemakers and AVR

[wlaldridge]

During my visit with my surgeon he gave me lots to think about!!

He told me that there is a very real possibility that I might need a pacemaker. He said that the area near the aortic valve is the area of "conduction" and sometimes the electical system gets messed up by the operation, requiring a pacemaker.

Does anyone know how true this is and how often it is necessary to install a permanent pacemaker? I know that this is just a minor thing in the "bionic man" scope of things but still would like to know as much as possible.

Thanks,

 

[MarkU]

All I know is that they installed wires for an external pacemaker as a "precaution" during my surgery and left them sticking out of my chest until just before I was discharged from the hospital.
In the past 18 months since my surgery the subject hasn't come up again with my cardiologist.

Mark

 

[ALCapshaw]

My 'guess' is that it is not very common since I've not read of many VR.com members with pacemakers. You may want to ask your surgeon for his experiece in this area. I suspect he is merely being thorough in alerting you to the possibilities. Generally, knowledge is a good thing but if it only adds to your anxiety, then it may not be so beneficial.

I went into atrial-fibrilation a few days after my AVR surgery which was corrected by their standard protocol after about 3 or 4 hours. I had two A-fib events around week 12, each of which resolved after a few hours. I went to the ER after the first one where they let me lay around until it resolved and then they sent me home. After the second one, I merely took another dose of my Beta Blocker and went to bed after it resolved.

These A-fib events are NOT considered life threatening as long as they resolve in a relatively short time (several hours or maybe a day or two?). I am on a fairly low dose Beta Blocker which seems to be working. I had the exact same experience after my Bypass a few years ago, i.e. a couple of post op A-fib events which resolved fairly quickly and never reappeared.

Bill, I know you are anxious about going into surgery, which is understandable. If you need a little help pushing you over the decision hurdle, ask your surgeon what will happen if you do NOT get your valve repaired. THAT should turn you around !

'AL'

 

[wlaldridge]

Al: When you see one of my other post to you on a different thread you will see that I have accepted the concept. My surgery is scheduled and I don't back out of things.

Mark: WIRES: what did they do with them?? Hope they didn't just yank them like the drainage tube so many folks indicate is removed so "gently". Do they attach electrodes permanently?? Every answer seems to lead to such "interesting" new questions.

Do not mean to seem a "pain" but someone told me to ask questions, questions , questions so I keep doing what I am told.

Thanks to all

 

[Nancy]

Hi Bill-

Joe is one of the few who have pacemakers. His heart was seriously compromised by rheumatic fever, so I truly can't say that surgery had anything to do with the need for a pacemaker.

The reason he had to have a pacemaker is because he had many faints, 3 of them extremely serious There was no pulse that I could detect in at least one of them. On all three occasions he just missed landing on some things that could have caused permanent injury. And I think that one of them is the reason he had to have a repair on his mitral. I think he tore loose some of the stitches from his recent MVR, because he fell like a tree in the forest. All of the faints were caused by a very slow heart rate. He also had the opposite problem at times with afib and a high heart rate. The decision was made to implant a pacemaker to keep the heart from going too slowly, and he took meds to keep his heart rate from going too fast. He still has chronic afib and will probably have it forever. There are times when his heart is in normal sinus rhythm. The pacemaker has been a lifesaver for him.

If there is anything I've learned throughout all the years that Joe has been battling with his heart, and all of the posts I've read here, it's that each person is an individual and their heart conditions are all different. So what works or doesn't work for one person, may not work for another. The only thing to remember is that most heart conditions can be helped with either meds or one gadget or another.

You keep on asking questions, that's what this site is for, I wish you well.

 

[Johnny Stephens]

WIRES: They don't "yank" them out, but they do pull them out smoothly. I was given a countdown; 3 ...2...1...blow! and instructed to blow out really hard while they pulled them out. All I felt was a weird tickling sensation that was over in about 1 second.

For me, anyways this was a non-event even though I fretted about it before hand.

 

[LUVMyBirman]

Hi Bill

I had a concern with my conduction system prior to MVR. My syndrome 'First Degree A/V Block' did not prolong. Though, I do have PAC's once in a while. Which are benign and don't bother me. They came on three months post op.

My surgeon and cardiologist informed.... as I age or have another MVR, my chances are about 20% that I will need a pacemaker. Not too concerned about it.

Unless you have a very progressed situation with your conduction system prior to surgery, i.e. you are symptomatic and will need the pacemaker regardless.....would not place too much emphasis on it.

As Nancy stated, it's a "lifesaver".
Not apprehensive about receiving one if need be. The first person that had a pacemaker implanted many years ago recently passed on at age 90. The pacer was inserted in the gentleman's 30's or 40's I understand!

 

[hhardt]

Pacemaker and AVR

Pacemaker and AVR

I had complications after my AVR that required the pacemaker several days later. I also had AF which the PM does not help. Was taking blood thinners due to the AF. Ended up in the ER after all the rhythms were varying wildly. Went back on amiodarone which calmed everything down. Had cardioversion several months later and so far am 1 of the 25% that stay out of AF for over a year. (Don't know where I saw that number)
I am now OK, played golf 2 days in a row this week, and doing natural things. My main complaint is periphal neuropathy (numbing of the legs and feet) which is my only activity drag now. The pacemaker does not bother me at all. Looking down at the grass every morning makes at all worthwhile, especially for us bovine types.

 

[Don]

Wires

Wires

My experience with the wires is about the same as Johnny Stevens. I don't remember the "blow hard" part. They came out easy. As Johnny stated: a "non-event". I was somewhat surprized to see that they were there after my first opportunity to see my chest after surgery. They were so neatly wrapped and perfectly coiled.
Best wishes,
Don
AVR; 4/12/2002; CCF; Cosgrave; Bovine Tissue Valve

 

[John & Joann]

Pacemaker

Pacemaker

Joann's 1st valve replacements was in 1971. The pacemaker came in 96. The valves were again replaced in 98. Atrial Fib and Flutter is fairly common with valve surgery. The pacemaker is a fairly easy procedure. (Normally) Joann had 3 complications with her installation. This is NOT common. Dr. said that he had seen all 3 problems, but never on the same person.

Pacemakers are usually dual chamber for valve issues. Enlarged heart, heart failure, etc. all are related to pacemakers.

Joann requires a pacemaker due to the Betapace medication. She takes this in place of Amioderone. We both did not like the side effects.

Hope that this helps to explain.

 

[Gnusgal]

pacemakers

pacemakers

I have had a pacemaker for the last 18 years. I'm now on my 4th. I got the pacemaker LONG before my VR (only two months ago). I do know that they went ahead and put the temporary wires in just in case my pacemaker wires were damaged in the surgery, but that didn't happen. They did pull the wires out "gently" but I was not told to "blow hard." Perhaps that would have helped. It wasn't exactly painful, more of an uncomfortable feeling. Not the "pinch" the nurse said it would feel like. Nevertheless, it didn't feel like they were ripping my heart out either... I'd say the chest tube was definately the worse of the two.

As for pacemakers, they are an incredibly easy surgery. Because of my heart defects I had to have my wires attatched to the outside of the heart (epicardial), where normally they run them through veins and into the inside of the heart (paricardial). When I was seven (that's when I got the first one) I was in the hospital for a week, but mostly just to get the settings right and so forth. I don't think they do that anymore. The last two replacements I've been able to go home the same day as the surgery. It is a very easy procedure. They don't have to go to the heart at all, just detatch the wires from the pacer and attatch the new one. The surgery only lasts about 45 minutes. And part of that is testing the old wires to make sure they are still good. As a matter of fact, for my third pacemaker, I was only given a local and sedative and the surgery was done by my cardiolgoist in the cath lab. I was even awake for part of it (I can say that calmly now, but I wasn't pleased at the time). I was back at work the next Monday (surgery was on Thursday). Just a little bit of soreness. I know with most people they are instructed to not move the shoulder for awhile to let it settle in, but mine is in the abdomen, so there weren't any restrictions like that. Just hurt to laugh.

I don't know what the likelyhood of a person needing to have a pacemaker after VR is, but I can assure you that getting/having a pacemaker is really not that bad...

 

[wlaldridge]

Thanks for all the good information and thoughts. I am not exactly obsessing about some of the side issues. I guess if I get through the opening in my chest and the stopping of my heart, I won't be too upset with a built in power source.

 

[Granbonny]

1 week

1 week

Hi Bill, One week tomorrow..Bet I don't need to remind you Just remember, take it easy everyday..Don't fret..Have a good weekend..Do you go in Wed. or early Thursday??Chat with us daily and you know I'm up early if you need an early a.m. coffe chat... Scottie goes Tuesday and you Thursday and you both will be chatting to us a week later. Betcha Bonnie

 

[wlaldridge]

Gosh IT almost slipped my mind. LOL as some say!!

I think I am a "pump head" before the pump. My pre op meeting is Friday and my youngest son is returning from Korea for this event.
I am trying to "take it easy" but, I am somewhat anxious.

Thanks for the offer of a.m. chat. Might have to do some. But no cofee, I gave it up when it became clear that there was no way out of this thing. Went to the dentist today got full x-rays and looked ok. Odd my surgeon has not given me any instructions other than to show up to the pre op meeting or the surgery will be cancelled. Darn, wonder if I might over sleep Friday??

I hope you win the bet about being back here in a week. How was your visit with your daddy?? Good I hope. Mine died at 48 my senior year of high school, I no doubt contributed to his early demise. Being a know it all teenager and all. He exhibited classic symptoms of heart trouble but I told him he was just "out of condition" and he put off testing till it was too late.

I guess it really is what you learn after you know it all that counts most.

More later,

 

[Christine]

wires and tubes

wires and tubes

vaquely remember them pulling the temp pacemaker, but i really remember pulling the tubes.. aparently my regular surgeon's er nurse left for the weekend before coming back to pull them.. (she always came when i was eating, not that i ate much hospital food) so i got stuck with the doctor covering the weekend shift who was not happy about them not pulling and he did it himself.. i think he was kinda pissed.. yanked them out and threw them in the waste basket by my bed... of all places..

good luck bill on your pacemaker operation..

christine