CRT-D Pacemaker Implantation Part 4

I’m writing this blog to help those who, like me, struggled with the whole concept of Pacemakers, CRT Pacemakers and ICD’s.

My understanding of the role of the various pieces of kit are :-

* A Pacemaker is used to help people with heart failure. It gives the heart a little help should it try to slope off and not do its job properly. It is usually wired to one ventricle.

* A CRT Pacemaker is also used to help people with heart failure except it is wired to both ventricles and will synchronise the beating of the heart. Making it more efficient and reducing pressure within the heart.

* An ICD is a device that monitors your heart, and should it slip into a life-threatening arrhythmia it will use electricity to shock the heart and put it back into normal rhythm.

It is possible to have a Pacemaker and ICD in one unit or a Pacemaker on its own. An ICD on its own will not provide any assistance to the heart unless it is a lifesaving situation.

The latest update of my own journey is:-

October 31 2017 – CRT-ICD fitted after two failed attempts to get the wires in the correct position.

December 20 2017 – A Device Check meeting at the Hospital. I was told the CRT-ICD unit was taking the load 68% of the time however to get any noticeable benefits it had to be operating at 80%+ . I had the option of increasing the toxic drugs I was on or having a AV Node Ablation togice the CRT-ICD unit to do its job. I chose ablation.

February 1 2018 – I had the ablation. I felt no better, and my heart was left at 80 BPM and I was scheduled in to have it reduce to 60 BPM. I was told to stop Bisoprolol and Amiodaron (Yippie!!)

February 28 2018 – I was told that the CRT-ICD unit was now operating at 99.6% efficiency and that my ‘Limp Mode’ was 34 BPM. CRT-ICD unit configured for 60 BPM.

I am slowly feeling better but how much of this is the CRT-ICD and how much is the drugs slowly draining from my system, I don’t know. Amiodarone takes 100 days to drain out so I am looking forward to May !!!

Please note this is based on what has happened to me and my understanding, always talk to your Cardiologist or EP.

Regards

Ogilvie.

[CDreamer]

Thank you for posting - very interesting as my next step may be Pace and ablate. Hope you continue to feel better.

[Hidden]

I have dual chamber pacemaker but do not have heart failure. I had open heart surgery to remove benign tumour and a cox maze procedure at the same time. My natural pacemaker was not functioning too well. I was very bradycardia with regular pauses of up to eight seconds. The pacemaker and my meds mean I can go to the gym 5/6 days a week for an hour each time

[Hidden in reply to Hidden]

Bradycardic I meant

[WhitstableWanderer]

Interesting and helpful post, thank you. By 'limp mode' do you mean your heart's natural bpm now?

[Hidden in reply to WhitstableWanderer]

Hi,

Yes. Should the CRT unit stop then my own natural pacemaker (AV Node) will kick in. It's nice to know thats there although I am 100% confident in it's abilities.

[Ktomoph_ in reply to Hidden]

Hi Ogilvie

Great to hear that things are getting better, and that you can stop taking some of the life saving but awful medication.

I too had the CRT-D fitted in September last year. I was fortunate in that the procedure was performed under general anaesthetic as I am such a phobic, and recovery was exceptionally speedy. The lovely EP cardiologist informed me afterwards that they were unable to access the AV Node at the time....and now the fear of yet another procedure hangs over me. The device I have has 3 leads - one each to the top chambers and one to a lower chamber, and a defibrillating mechanism in place.

Forgive me if I am wrong but it is my understanding that if the AV Node is ablated, then the heart is totally reliant on the wires that keep the heart beating in rhythm and the defibrillation part will kick in if these or your heart stop. But if the AV Node is not ablated that it will kick in if needed?

I am trying my hardest to understand every part of what is happening! But one thing I must say is that - touch wood - I do feel so much better. I am able to do so much more again.

I have had 'fun' times with the recorder/reader device! Think its because I live where time and technology has yet to really be a viable necessity!

I look forward to any info regarding this

[Ladysmith64]

Hi Ogilvie I too had AV Node ablation approx 18mths ago and a2 lead P/m fitted and operational within 2 mths. I saw and felt little benefit or improvement to my QOL until December 17 when with my G P consent I reduced Bisoprolol to 1.25 daily and 4weeks later eliminated totally. Now killer migraines have all but disappeared and I hope I can begin to function "as normally as poss" going forward. So glad to read your post and garner encouragement from it however you state that "should the CRT fail " then your own natural pace I.e your AV Node will kick in. Surely is it not your AV node that's been ablated and your hearts beat is solely reliant on P/ M? Or conversely have I misunderstood the multitude of info. received during last year or so. Best Wishes Ladysmith

[Hidden]

Hi There,

My understanding is that the AV Node is a mass of cells that they burn out (ablate). They don’t burn all the cells and those that are left will kick in should the CRT unit fail. When I had my last hospital visit they were able to pace down the CRT unit to see when the hearts natural pacemaker kicked in (34 bpm). There is another gentleman on here and his will kick in at 54 bpm. We are all different, I guess, and I am pretty nosey about people messing with my insides so ask a lot of questions.

There is also a sleep mode on the CRT Unit. Mine is currently switch off. The sleep mode will allow your heart to go slower as normal, presumably to aid sleep. You must tell the hospital what time you go to bed and they configure it appropriately.

I have told my wife there is a "nookie" mode on the device (there isn’t) and we have to tell the hospital when we do the "dance with no pants". She was mortified. I kept it going for a few days but eventually she twigged when I suggested a 90 second slot every Sunday morning. She knew I would never manage 90 seconds!

Regards

Ogilvie