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What I learned about lead placement

Posted by ted3 @ted3, Jul 31 10:03am

I received my PM on April 18, 2025. It's a Medtronic Azure DDDR. I have had 3 tune ups to enable me to run without my PM suddenly dropping my HR off the edge of a cliff. The Mayo Device team contacted Medtronic for input which was implemented successfully on June 30. I am now back to running 20 miles a week just like I used to. One of the consequences of my latest configuration change is that I'm being paced at 91% in the ventricle. My research indicated that that increases my risk of Pacing-Induced Cardiomyopathy (PICM), reduced ejection fraction, dyssynchrony (the ventricles contracting out of sync), increased risk of heart failure and atrial fibrillation. This past Monday I met with Dr. Shen, a renowned EP, and asked about these concerns. Dr. Shen said that within the past 5-6 years, ventricle leads are placed closer to the physical AV node or septally. Dr. Shen said that the septal placement eliminates the risks which of course concerned me. So now not only have I returned to myself physically, but I do so without the fear of suffering the consequences of high ventricle pacing. Given where I was in mid-April (35 heart rate and near incapacitation due to 2:1 AV node block), it's miraculous that I have recovered completely! All the best, Ted

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cottagecountry | @cottagecountry | Aug 1 8:07am

An excellent and extremely helpful update, ted3.
I am due for my annual examination of my CRT-D (Abbott/St. Jude Medical Neutrino NxT HF) next week. It has been busy "oversensing" SVTs resulting in numerous, almost daily and essentially unnecessary reports being sent to the arrhythmia clinic which monitors my device. I am completely unaware of these episodes as I am asymptomatic.
I suspect I may be moved from the current DDD mode I am in to DD1 which would result in an improvement of the discriminators or filters, thereby reducing the above mentioned reports. A tech support rep from Abbott will be attending my appointment along with the electrophysiologist who did the original implant.
I have had my CRT-D or biventricular pacemaker for 3 years and it is designed specifically or those who have heart failure. However, I am very fortunate. My EF at the time of surgery was 19% and falling. As of my last echocardiogram, my EF has improved to 56% which is considered to be in the normal range.
Congratulations on being able to resume your running program! And thank you again for sharing your knowledge. It made for a fascinating and insightful read. Take care.

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2 replies
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ted3 | @ted3 | Aug 1 9:12am
In reply to @cottagecountry "An excellent and extremely helpful update, ted3. I am due for my annual examination of my..." + (show)
Profile picture for cottagecountry @cottagecountry

An excellent and extremely helpful update, ted3.
I am due for my annual examination of my CRT-D (Abbott/St. Jude Medical Neutrino NxT HF) next week. It has been busy "oversensing" SVTs resulting in numerous, almost daily and essentially unnecessary reports being sent to the arrhythmia clinic which monitors my device. I am completely unaware of these episodes as I am asymptomatic.
I suspect I may be moved from the current DDD mode I am in to DD1 which would result in an improvement of the discriminators or filters, thereby reducing the above mentioned reports. A tech support rep from Abbott will be attending my appointment along with the electrophysiologist who did the original implant.
I have had my CRT-D or biventricular pacemaker for 3 years and it is designed specifically or those who have heart failure. However, I am very fortunate. My EF at the time of surgery was 19% and falling. As of my last echocardiogram, my EF has improved to 56% which is considered to be in the normal range.
Congratulations on being able to resume your running program! And thank you again for sharing your knowledge. It made for a fascinating and insightful read. Take care.

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Wow! 19 to 56% Just shows how amazing these devices are. Good luck with your tune up!

REPLY
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deniseheart | @deniseheart | Aug 2 7:56am
In reply to @cottagecountry "An excellent and extremely helpful update, ted3. I am due for my annual examination of my..." + (show)
Profile picture for cottagecountry @cottagecountry

An excellent and extremely helpful update, ted3.
I am due for my annual examination of my CRT-D (Abbott/St. Jude Medical Neutrino NxT HF) next week. It has been busy "oversensing" SVTs resulting in numerous, almost daily and essentially unnecessary reports being sent to the arrhythmia clinic which monitors my device. I am completely unaware of these episodes as I am asymptomatic.
I suspect I may be moved from the current DDD mode I am in to DD1 which would result in an improvement of the discriminators or filters, thereby reducing the above mentioned reports. A tech support rep from Abbott will be attending my appointment along with the electrophysiologist who did the original implant.
I have had my CRT-D or biventricular pacemaker for 3 years and it is designed specifically or those who have heart failure. However, I am very fortunate. My EF at the time of surgery was 19% and falling. As of my last echocardiogram, my EF has improved to 56% which is considered to be in the normal range.
Congratulations on being able to resume your running program! And thank you again for sharing your knowledge. It made for a fascinating and insightful read. Take care.

Jump to this post

That is fantastic improvement! Keep it up and all the best. Denise

REPLY
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cottagecountry | @cottagecountry | Aug 2 9:18am

Thank you, Ted and Denise.

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