Pacing to help obstruction

[kathyn2]

I have a question I hope someone can answer or several someones. I have hocm. 2 years ago when I got my ICD for ventricular tach (and now A fib) they set a pacer in some fashion that is suppose to help relieve obstruction. I never knew if it did much or not as I still have/had plenty of symptoms.

Well the past few months I have shown signs of congestive heart failure perhaps or fluid on the heart. I carry alot of fluid in my legs and feet at times too and this is all compounded by severe kidney failure for which I am not on dialysis yet. It is very difficult for them to treat me with lasix because of the kidney failure. For one thing it doesn't work very well to get rid of the fluid and it worsens my kidney function severely so I do not take it much and when I do it is a small dose.

To get to the point, I read on here a few years ago and I think it was from Lisa S. that some experts thought that pacing to relieve obstruction could cause congestive heart failure. I saw my EP last week and I asked him to shut the pacer off to see if the pacer could be causing congestive heart failure and that I had read about it somewhere. He actually thinks the pacers help hocm and he said it wasn't my condition that pacers may cause heart failure in but he did agree to shut it off to see how I felt and and it is off now.

Well I feel worse without the pacing. What it does is pace the bottom portion of your heart to help relieve obstruction and I definitely feel my heart working alot harder now and more shortness of breath.

So can anyone tell me if pacing causes CHF??? How come there is no new news or treatments for HOCM or HCM. Even tho my doctors are not experts (there are none in my area) they are fairly well up on HCM. I am thinking of calling today to see if I can get in this week and have it turned back on. And btw, even tho the pacing helps some, I have way too many symptoms!

[Bruce42]

Re: Pacing to help obstruction

I think -- this is just me thinking -- that there is a difference between ordinary, everyday pacing (I have a pacemaker on which I am 100% dependent after complete heart block), and a treatment they were trying for obstruction a few years back called "dual chamber pacing." I don't know the details about "dual chamber pacing," but I think that may have been the treatment that they were concerned about having adverse effects--it is no longer the recommended treatment. (For obstruction that does not respond to medication, the options now are myectomy (the gold standard) or alcohol septal ablation.)

Someone at the HCMA office should be able to verify this and provide some backup information. Moderators?

PS Oops--sorry. Forgot this is the "ask the HCMA" section. I'm not one of the moderators, so wait for the moderators to chime in.
(I've figured out how to edit, but not move or delete, this post.)

[Cynaburst]

Re: Pacing to help obstruction

Bruce - You are fine. No worries. And the dual chamber pacing (its called DDD pacing) was the one that is no longer used. I am not sure about whether it causes heart failure. It seems like I might have read something like that, but I can't recall offhand where. Lisa won't be back in the office until after the 4th, but maybe she will see this and comment.

[Pam Alexson]

Re: Pacing to help obstruction

Here is a snipet: you could contact the writer for more info.


Difficult Cases in Heart Failure
Mandeep R. Mehra, MD; Hector O. Ventura, MD
Editors
Pacemaker-Induced Mitral Regurgitation as a Cause of Refractory Congestive Heart Failure During Pacing Therapy in a Patient With Hypertrophic Obstructive Cardiomyopathy
Hajime Kataoka, MD
From Nishida Hospital, Oita, Japan
Correspondence to Hajime Kataoka, MD, Internal Medicine, Nishida Hospital, 3-3-24 Ohte-machi, Saiki-city, Oita 876-0831, Japan
E-mail: [email protected]
ABSTRACT
This report describes a woman with hypertrophic obstructive cardiomyopathy in whom initial hemodynamic improvement by dual chamber (DDD) pacing with short atrioventricular delay was excellent, but severe mitral regurgitation developed during the subsequent follow-up period, resulting in refractory congestive heart failure. There were two possible explanations for the origin of the complicating mitral regurgitation in this patient: pacing-induced semiclosure of the mitral valve, or left ventricular asynchrony caused by right ventricular pacing. Heart failure in patients with hypertrophic obstructive cardiomyopathy who undergo placement of a DDD pacemaker to improve not only mitral regurgitation but also heart failure symptoms can be associated with systolic mitral regurgitation as the cause of failure in DDD pacing therapy.

This book link will provide a better theory :

http://books.google.com/books?id=E4P...esult&resnum=3

There is a lot of info in this link:

http://cme.medscape.com/viewarticle/527545

I know this may not be possible but of course the best approach would be to see one of the experts of HCM recommended by the HCMA. You have a very big challenge and obstacle with chronic renal failure with your HCM.

Hope this info has been of use...and wishing you well.

[kathyn2]

Re: Pacing to help obstruction

Yes Pam, between HOCM and Chronic renal failure without much renal sufficiency left it makes it very difficult. Most likely a myectomy is out as it would probably kill the little kidney function I have left and I dont' want to be on dialysis and am trying to preserve what little function I have left. And what helps one condition can harm the other. It is really a fine line to walk. I am just grateful for every day that I get. I just don't know what to do about the pacing but I am not convinced I am being DDD paced.

I hope when Lisa comes back she will comment. I will also print off your info and take it to my doctor and ask about it.