Biventricular pacemaker due to poor ejection fraction

[squeak777]

My husband had quad bypass on 9/6 to virtually a half of heart (scar tissue and non-functioning 1/2 heart due to unknown heart attacks).  He is 60 y/o, diabetic with an ejection fraction of 13-18% that solely went into his internist for a physical when they found 100% blockage in 3 arteries and 90% in another.  Three mo. post-op echo shows 25% ejection fraction so electrophysiologist wants to install biventricular pacemaker (ICD).  The heart surgeon had told us one month ago that if his echo was at least 30% he would be happy and due to condition of heart he thought we should leave everything alone.  Now after seeing the electrophysiologist (who was not there at time of cabg (not done on bypass machine due to heart surgeon not sure of being able to restart heart) we are scared to death.  Is this a procedure that is safe due to my husband's condition?  Before cabg he even had to have some special mri out of town because where they put a metal box over his chest so they could see through massive scar tissue because they couldnt even do a heart cath due to scarring.  I know our heart surgeon takes a conservative approach but I also know he is the one that saw my husbands heart and knows its condition best.  Do the positives outweigh the risks?  These doctors are in the same office but it appears they do not communicate often, I am so fearful about the procedure.  The electrophysiologist explained chances of sudden death if he doesnt have it but is this a common surgery, they did indicate before surgery that my husband is in end-stage h/f. Thank you, I am desperate for help.

[squeak777]

We are still apprehensive about this procedure due to the fact that my husband's heart is about 50% functional due to massive scar tissue from previous heart attacks and cant understand how they are going to be able to find the viable tissue to connect the leads to.  He is scheduled to have this done next Monday and wondered if you had any info on this.  I am terrified that it will stop his heart and they wont be able to resusciate him.

[squeak777]

Does anyone have any considerations or concerns about a particular brand of defibrillator/pacemaker?  They have not told us what they are going to use.

[squeak777]

Thank you so much for your comments, they are quite helpful.  Our doctor did indicate that my husband's heart should pump like a bellows works, equal force on both sides and it is not, one side is weaker than the other so that must be why this procedure is indicated.  Your story is truly inspirational and helped a lot!  I read it to my husband and it has helped him to remain optimistic.  The Institute that we are being treated by has an excellent reputation I believe and know that the electrophysiologist that will place the device successfully treated a 94 yr. old patient with the device.  I thank you again for your kind words and helpful information.

[PikaPika88]

Hi DottyCece or any ECG technician,

I see you can answer most of the question.  I wish to know that the ECG from Lead V1 to V6 are stand for what area of the heart?
Mine one change a lot in one year.  Now didn't turn up with any spike at all in these 6 leads.  It only left with a mung bean side blot in a quite straight line. Do you know what's this stand for?  Could it be my heart not pumping efficiently? Atrial or Ventricle?  LBBB is part of that, right?  Please help.

Pika.

[Bromley]

Hi. I dont know a lot about this as I am not a medical professional. BUT, I think the subject of Biventricular pacers is sufficiently new and challenging that you want to make a point to seek the best medical care you can get.

These days its getting easier to do this.  For instance, you can peruse the resumes and qualification of doctors online at

http://www.clevelandclinic.org/heartcenter/pub/staff/default.asp
http://www.mayoclinic.org/cardiovascular-rst/arrhythmiaclinic.html
http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm

and get a feeling for some of the issues by visting sites such as

http://www.medscape.com/cardiology-home
http://www.medscape.com/crm-home?src=pdown
http://www.hrsonline.org/

Then it is still possible (I think) to get an appointment in cleveland in a one week time frame. So, you could confirm an appointment, say,  tomorrow, get your e-tickets online for convenience, and possibly see a doc in person next friday.  

Later,

-B.

[DottyCece]

The problem with right ventricular pacing is that they create a BBB.  That results in a asynchronous contraction of the ventricles.   With the biventricular pacer, both ventricles are paced at the same time so there is synchrony of contractions and you get a better cardiac output. That's why the Doctor was saying that the electrophysiologist would need to study the patient to see what is really happening in order to make a prediction as whether a biventricular pacer would be helpful.  They told me that it is helpful in about 70% of patients.  I have been described as having a remarkable improvement in function.

[PikaPika88]

Dr in here said before if the pacemaker is pacing right ventricle, it shows LBBB.  I'm confused, the biventricular pacemaker is pacing right and left ventricle, so it'll show LBBB and RBBB.  Does it mean all the time with complete heart block?  Pika.

[DottyCece]

I have a biventricular pacemaker and it has made a world of difference for me.  I have a long story so I will just summarize it.  I had a mitral valve replacement that went very badly and had to have it all redone about 11 months later.  During that time I had multiple cardioversions for rapid atrial flutter/fib.  Two ablations were done with poor outcome.  I went into heart failure with an EF of 30% and had very poor function.  I couldn't talk and breathe or walk and breathe...it was awful.  Going to work was a real effort each day.  I tried to exercise and couldn't.  So I did pursue a biventricular pacemaker at my cardologists urging.  I had the old pacemaker explanted and they put in the new one with an ICD because I do have sustained ventricular tach.  It has been 16 months now and my EF as of yesterday is 50%.  I feel so much better.  I realize that it is a combination of the biventricular pacemaker, heart failure drugs, and daily exercise of at least 30 minutes per day that is making all the difference.  I had a wonderful medical team that offered so much support for me.  They all consider me a remarkable success.  My function has improved to where I am almost normal but I still have have cardiac disease.  I could be a poster person for Medtronic.  I realize that this doesn't work for everybody but I consider myself extremely lucky and fortunate.  I told my cardiologist yesterday that I really want to give to others what all of them have given to me.  What I would say to you is to take your drugs, look into the birventricular pacemaker, and exercise each day.  Though I am sure there could be complications for the pacemaker implant, I had none.  Just make sure you go to someone who does a lot of these. It is a bit tricky to get the left lead wire in place but if the physician does a lot of these you should be fine.  Good luck to you.  If you have questions, I would be happy to respond from my persepctive only.  I am only one person who had fantastic success in the end.  it will be three years since all this started in 2003 and just finally I feel I have my life back.  Good luck to your husband.

[Cleveland Clinic]

squeak,

Its a difficult situation when you have multiple physicians telling you different things.

1st if your husband does not have an ICD he should have one. Regardless of the biventricular pacer, an patients with low ejection fractions (even 30%) live longer with this device.

There are a lot of technical factors that might help determine if your husband could recieve benefit from a biverntricual pacemaker. Things such as symptoms, his ECG and the mechanics of the way his heart beats all come into play.

Generally, surgeons are not as up to date on the specifics of who benefits maximally from these therapies as much as the electrophysiologist.

Perhaps seeing a cardiologist who specializes in heart failure could help you decide on what therapies to take. Here at the clinic, we have a whole division specializing in heart failure. We also have electronic consults available online. Overall, a biverntricular ICD does sound reasonable from what little information you provide.

good luck