His-bundle pacemaker technique

Your replies are coming through just fine, @corjianne

Thanks, Teresa.

Hi @corjianne,

Your electrophysiologist is right about His Bundle Pacing (HBP) which has emerged as a feasible, reliable alternative to traditional pacemakers. Multiple studies now show that HBP offers much better outcomes – here are two established studies:
– His Bundle Pacing: A New Frontier in the Treatment of Heart Failure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020230/
– Long-term outcomes of His bundle pacing in patients with heart failure https://heart.bmj.com/content/105/2/137

@corjianne, I completely understand your concerns about the uncertainty of a relatively new therapy, but I hope this brief Q&A will reassure you about the potential and safety of this technique; I’ve copied some notes for your convenience –
"The barrier is educational and teaching physicians exactly how to do it. But I think that’s easily accomplished and we will see that in the near future and I think we will see far more physicians using His-bundle pacing than ever in the past.”
https://www.practiceupdate.com/content/permanent-his-bundle-pacemaker-registry-implications-for-clinical-practice/65304
Boston would probably be the closest for you, in terms of travel; might I ask if you would consider coming to Mayo Clinic? Mayo Clinic cardiovascular surgeons are on the leading edge of treating cardiovascular and cardiothoracic conditions, including those that are rare and complex – they use the latest innovations in heart surgery. You may also wish to view some of the patient stories that attest to the fact that Mayo Clinic is recognized as one of the top Cardiology and Heart surgery hospitals in the nation: https://www.mayoclinic.org/departments-centers/cardiovascular-surgery/sections/mayo-clinic-experience-patient-stories/orc-20123433

Please let me know if you need any more information, @corjianne; have you decided on a time-frame for the procedure?

Kanaaz,
Thank you very much for this information. I'll read it now. I haven't decided on a time frame because I haven't decided if I'm going to have the procedure. I believe the information you sent me will help me to make my decision. Mayo Clinic is a possibility.

corjianne @corjianne ,
I would like to comment the discussion ( I'am a bit late, but all the posts of mayo clinic connect did not come in the mail entry, but in the bulk mail , I do not know why). I do not know ,if you have even heard of digitoxin.it is a very old substance. nowadays it had a come back, there is a two year trial in a university clinic /Germany. the aim is to investigate, if digitoxin can reduce the numbers of patients with congestive heart failure , when they need a treatment in the emergency department..
let me explain my history: Since jan.2018 i have a two chambers pacemaker because of a block in the electric transport between the right chambers..I had no problems, but since last december I noticed gain weight, I lost my energy, I had problems with breathing. To cut a long story short, I felt miserable. the cardiologist confirmed the bad situation, serious congestive heart failure, most probably, induced by A-fibrillations/pacemaker electrode. the right ventrikel 's reaction was an serious arrhythmia. in spite of a betablocker (and bloodthinner). the cardiologist decided to give me digitoxin in addition to the other substances.
After 10 days I had a full recovery !! , also confirmed by the echocardiography., no heart failure anymore. I got the bicycle out of the garage, I was very relieved. I still take a low dosis. I would be very interested to hear, the opinion of american cardiologists. I'm a dutch woman living in germany.

Hello @yoanne and thank you for joining this discussion.

I am glad to hear that you have noticed an improvement in your symptoms. It sounds as if you have been taking digitoxin for about a year now, is that correct?

Perhaps @kanaazpereira will be able to shed some light on the use of this med in the U.S.

@yoanne, have you noticed any side-effects since you began this treatment?

@hopeful33250 ,
hello teresa,
I got the pacemaker january 2018. when I left the hospital they told me,that I had many atrium fdibrillations. but this is not uncommon, I should not worry about it. my medications were bisoprolol 7.5 mg/d + a blood thinner Eliquis .November 2018 I had a pacemaker check. the cardiologist told me, that I had 94% Fibrillations in the atrium, that means that the pacemaker electrode in the atrium was useless.
I depended more or less on the electrode for the right chamber. a couple of weeks later I noticed loss of energy, in the beginning I had to leave my bicycle in the garage, 2 weeks later I didn't even manage the walk to the bus. my weight went high, but I did not see any odemas in the legs. but apparently I got oedema in the lung, so difficulties with breathing (dyspnoe). I discussed the situation with my family doctor. she gave me a diureticum and she took care of an appointment with the cardiologist. (in Germany the patient has to wait a long time) . Februar 2019 I saw the cardiologist, the echocardiography confirmed my bad condition.: all (!!) the heartvalves were insufficient, even my mitralvalve ( I had a minimal invasive mitralvalve reconstruction 3 years ago) was highly insufficient, which was a great shock for me. . of course I did recherche in pubmed. and I knew, that in such a case they deactivate the electrode in the atrium. but that didn't work, because, like he said, the problem is located in the tissue of the right chamber. so he suggested digitoxin - 0.07 ng/ml.

to answer your question, I started the digitoxin only in februar this year. 10 days later I was fully recovered. 6 weeks later they measured the blood concentration of digitoxin (very important!!).. this was too high, so I started the lower dose (0.05 ng/ml).

you asked about side effects, I have none, but it is very important to choose the right dosage, depending on the weight of the patient.
Yoanne

Hello @yoanne,

I always think that Mayo Connect is a way to learn from others' experiences and I really appreciate the detailed information you provided on your symptoms, diagnosis, and treatment. This was certainly a learning experience for me and I'm sure it will be for others as well!

I admire how proactive you have been in finding an answer to your problem. Your research most certainly made a difference!

Hi @corjianne,

I’m so glad – I hope the information will prove helpful. If you decide to choose Mayo Clinic, I am confident that you will be in the best of hands. The contact information for Mayo Clinic (Minnesota, Florida and Arizona) can be found here:
http://mayocl.in/1mtmR63
I wish you all success – let me know if you have any questions or require any additional information.

Thanks, Kanaaz. I'm still researching. The idea of having this done scares me, but I'm not doing well this way, so. . . .