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benefits of biventricular pacemaker
My mother is 83. She has had irregular heartbeat for nearly 20 years and had a pacemaker implanted 3 years ago. Her last echogram showed her EF to be 20% and she has had several episodes of congestive heart failure. She is physically run down.....weight loss, loss of muscle, not to mention depression. Her cardiologist wants to implant a biventricular pacemaker. I am wondering if the benefits will out weigh the risks at this point. She does not tolerate surgery well and I am concerned about the rehabilitation period.
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Does anyone know if they have to remove the old pacemaker (which is a dual lead) or do they just add another lead to it?
Thank you for your responses! We will just have to take it a day at a time and see what happens.
Are they speaking of another pacemaker or of a biventricular ICD (implantable cardio defibrillator)?
The guidelines indicates that bellow 30% EF, the ICD is recommended to avoid risk of sudden death. If this is the case probably they need to extract the existing leads, which is a delicate operation.
The use of bivent pacing is recommended if the movement of the ventricles is not in sync. Or she has a long QRS interval (more than 120ms). In those cases she might feel better after implant.
But of course she has the last word.
Jesus
The guidelines indicates that bellow 30% EF, the ICD is recommended to avoid risk of sudden death. If this is the case probably they need to extract the existing leads, which is a delicate operation.
The use of bivent pacing is recommended if the movement of the ventricles is not in sync. Or she has a long QRS interval (more than 120ms). In those cases she might feel better after implant.
But of course she has the last word.
Jesus
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The implantation of an ICD is pretty simple, and the rehab is pretty short. The main problem with the new implant is keeping a patient from pulling the wires loose before they have had a chance to heal into the wall of heart. However, the removal of the existing pacemaker might be dangerous, I can't say because I didn't have another pacemaker prior to the ICD implant.
The total cost for the ICD implant is close to $250,000, including the surgeon, and follow up visits. With the "new" medical laws the next question would be if the insurance would cover the cost........the, "does the benefit outweight the cost?", which Obama is trying to put into place. With the new law, which is being worked on right now, if a patient is over 59 then they most likely won't qualify for the surgery. So, I wouldn't sit on the idea for very long, but either do it, or not, as soon as possible.
The pros of an ICD make it worth it, from my point of view, but the cons are, for some, hard to deal with when the device is in their chest. Mainly the fear of actually having it do what it's designed to do, which is pacing your heart, as well as shocking it to get it going again, should it stop. Also, the device is to be removed upon death, and for some that thought is hard to deal with.
I've had an ICD for 6 months, and I now have a monitor that allows me to send the information from it, 90 miles away to my cardiologist, and it can all be done while I'm asleep. The monitor can be borrowed for the remainder of the patient's life, free of charge. It allows the doctor to keep track of what is happening inside my chest, and it gives me peace of mind, since I'm so far from medical help. The benefits of the ICD, for me, is the pacemaking, along with the knowledge of knowing if my heart stops that the device will bring me back. You don't have to be 90 miles from your doctor, in order to have the monitor. You just need to have the implant in order to qualify.
Did the device make me feel better? It's hard to say, because I started dialysis about the same time I had the implant. I do feel better though, with more energy, and a feeling of security. However, I don't know which one did me the most good, or whether it was a combination of both. It's too soon to know if the device will do what it is designed to do, but I do like knowing that it is supposed to.
I hope something I've told you helps, but medical care is a gamble at best, and sometimes you win and sometimes you lose, so it's important to do what your mother wishes and not what you want done, as she will be the one affected the most by the outcome.
I hope the best for both of you.