How to resolve CI in 50 yr. old pacemaker patient?

My husband has been totally reliant on a pacemaker since unsuccessful surgery for WPW 27 years ago.  Recent nuclear testing shows CI although his pacemaker is rate-responsive.  He's at the end of life of his 3rd battery.  One failed lead was replaced 13 yrs ago and so 3 are in place.  He now needs a 4th lead but has ongoing circulation issues from the space occupied by leads.  Would a dual-sensor pacemaker be likely to help the CI?  Would all models require 2 new leads instead of one?


This discussion is related to Chronotropic Incompetence.

[PikaPika88]

Hi, my first pacemaker put in for my wpw 27 years ago.  I'm now 51 yr old.  I also had a leaking leak in 1994.  I end up with the complete heart block.  I'm not the pacemaker dependent.  Now I have a 2 leads St Jude pacemaker.  I also got 3 leads in my heart.  The current pacemaker is number 4.  It implanted in 2002.  

Not the new model require 2 leads.  It depends how many leads that your husband needs.  Oh, I rather say it depends your husband's EP choose how many leads for him!  They're one lead, two leads. three leads and even four leads pacemaker in the market.  

Does your husband still has wpw?  Was he had the open heart surgery for wpw?  I would really like to know why he needs a 4th lead?  I hope it is not the heart failure!

[rawise]

Thanks for the response. My husband had open heart surgery for wpw which ended up severing all of whatever wpw patients have too many of, thereby necessitating a pacemaker. My husband's pacemaker requires 2 leads (and I had thought all pacemakers did).  I also understand leads can't be removed.  So when 1 of the originals failed, a 3rd was installed.  Now the 2nd original is failing. Even though the pacemaker is a rate-adaptive type, it's not speeding up his heart on exercise.  I've read that a certain type of pacemaker incorporating 2 different types of rate-adaptive sensors can improve the situation, but they seem to require 'bipolar' leads.  I assume he's got unipolar leads.  Don't think he has room in his artery? vein? for more leads.

[BLM_56]

There are, indeed pacemakers that only use one lead.  Mine (also a St. Jude's, PikaPika88) only has a single lead.  It is both rate adaptive and threshold adaptive.  It also communicates with the outside world through an inductive probe placed over my heart at the EP's office.  

Unfortunately the rate adaptive devices don't trigger on what the body would normally use.  The one I have has 3-axis motion sensors.  Actually the motion sensors are accellerometers.  That means they sense accelleration in one of the three bodily axes - vertical, lateral, fore-aft.  Walking is fine.  It senses my footsteps and goes up nicely.  Climbing stairs - alsono problem.  Bringing in the groceries - not fine.  Carrying a heavy load I walk differently and don't trigger the sensors.  So my body is wanting 90 bpm maybe 100+ and the robot is totally oblivious.  Gets a tad interesting.  I tried an experiment at Sam's club a few months after I got my pacer.  I walked over to where they have the (very nice but kinda expensive) exercise equipment and stood still until my rate returned to its default.  Then I got on one of those eliptical trainers and started going at it - hard.  Was starting to get seriously winded and checked my rate.  Still at default.  Tried a stair-stepper.  Same result.  Didn't even try a recumbent bike 'cause I knew that wouldn't do the trick.

Your Ep will discuss with your husband (and you if you're anything like my guardian angel) about what type pacer and leads etc.  Just know that there are always gonna be things he cannot do.  At least until they figure out how to sense, trigger off the SA node itself.  GAD! but I hope they are working on that one.  Maybe they willhave that ready whan I need my first replacement in '18.

[PikaPika88]

I was lucky enough to shake my head off for open heart surgery.  After 3 years from the offer of open heart surgery, I had His bundle ablation.  I'm still having wpw tho........  Now the left side of my heart is getting lazy.

The first 2 pacers with a single lead at right ventricle.  The last 2 pacers with two leads at right atrial & right ventricle.  I can carry heavy things with no problem eg. baby!  I think my pacer also doing something that I don't like.  Every morning, once I awake....... it paces my heart runs like an express train.  Doctor said it senses I was awake then it top up my heart rate and ready for me to run for the day.  BLM_56, it senses my brain too!  It is horrible!

[rawise]

I like the way you think.  I'm surprised at the results with the stairstepper--does the sensor actually work on altitude rather than movement?  
Are you instructed to avoid the activities that aren't picked up by the accelerometers?  (I don't want to ask the doctor in front of my husband...he would need some time to accept the idea of early retirement from a physical job).  
Any insight on PikaPika's 'brain-sensor' technology?