Pacemakers after Aortic Valve Replacement

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michaeljquinn

Member
Joined
Oct 4, 2020
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10
I am moderate AVS but am concerned about the need for a permanent pacemaker after AV Replacement. Is it a common occurrence or not. I will discuss this with my cardiologist
 
I had my surgery long before pacemakers came on the market and have never had a doctor mention a need to consider one. I was diagnosed with chronic A-fib a few years ago but it is being treated successfully with medication.

I know of many other people that have not required pacemakers after surgery. I also know of some who get pacemakers years later for reasons other than valve replacement.
 
I needed a pacemaker as a direct result of my AVR surgery, 6 years ago. It was inserted a week after the "main event". The risk is low, but given the heart's electrics run close to the valve some damage is possible.

It was a few months later before I even thought about what a pacemaker would mean, and whilst I can no longer go on some roller coasters because of their magnetic brakes, and need to go for annual checks, it has had a minimal effect on my life.
 
I am one of only a couple of people on here who did require a pacemaker. It's not super common. You're more likely to not need one. I go on all the roller coasters ;) and agree that it has minimal effect on my life. I was not mentally prepared for it so it bummed me out for a while but I am happy now.
 
I was told pre-surgery that most people getting AVR do not need a pacemaker. Everyone I know with a pacemaker have for reasons not related to an AVR. That being said, you can have an AVR and later get a pacemaker for a separate reason. The classic example is that about 20% of all tissue valve recipients wind up on warfarin for reasons unrelated to their valve.
 
michaeljquinn said:
I am moderate AVS but am concerned about the need for a permanent pacemaker after AV Replacement. Is it a common occurrence or not. I will discuss this with my cardiologist
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My wife has had 2 AVR's, 1st was from a ROSS and 2nd and final a St Jude MV, and no pacemaker.

Anyhow, what is your concern re: a pacemaker if you do need one?
 
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Valve jobs don't necessarily require pacemakers. But other cardiac issues can make one a lifesaver. And not all PMs are the bulky, traditional kind.

My husband had MV repair in 2007 to replace chordae ruptured in a head-on car crash 17 months prior. He had temporary a-fib during recovery and went on warfarin for 6 months.
Several years ago, he began having syncope and near-syncope episodes, once while visiting a new AVR patient at a hospital and landed in the ER overnight for observation, two other times while we were at stores, don't remember the others. He wore holter monitors several times and finally our cardio said it's time for a pacemaker.
Fortunately, my husband's conditions (sick sinus syndrome, a-fib, bradycardia) qualified him for a Medtronic Micra AV and he got one implanted Feb. 17, 2020, just 5 days after Medicare approved coverage in the U.S. It is a dual-lead PM and is inserted directly into the heart via catheter. He has had no dizziness or syncope since implant. He has Alzheimer's and as his POA, I would not have approved of a traditional PM, so I was pleased he could get the Micra. The experience was like going in for a heart cath: lying flat for 6-8 hours, staying overnight, taking it easy the next day. That's it.
The Micra AV is not much bigger than a capsule of amoxicillin or another RX or OTC. I'm not sure about explaining one, but I did clarify with Medtronic that it does not require removal prior to cremation; traditional PMs must be removed prior to cremation.
 
I wrote this a month ago
vitdoc said:
Basically two primary reasons for a pacemaker. The first and most common is when the normal pacer in the right atrium starts to punk out and the rate slows. A pacer is placed that signals the right atrium to contract and the signal is sent to the ventricles to contract when the normal rhythm drops below a preset number.

The second reason is when there is a disruption in the signal getting to the ventricles from the atrium. Some beats may get through (second degree block) or no beats get through ( third degree block).

Sugery around the aortic valve even TAVR can cause 3rd degree block.

Sometimes the ventricles will beat on their own without any signal at a very low rate say 20 beats/min. Other times they don’t beat at all without a signal.

I developed 3rd degree block after my third surgery which was replacing the aortic valve and repairing a aortic aneurysm. I had no intrinsic ventricular beat. Been paced for 14 years . And I am considered pacemaker dependent.
No pacer no life . Those with slow atrial rates are not pacemaker dependent.

To make matters a bit more complicated the usual routine is to pace the right ventricle and have the signal spread to the left. But having wires in both the right and left ventricles makes the heart more efficient. Generally biventricular
pacing is done for people in failure. It probably should be done for everyone who needs 100% pacing. I was not in failure but I convinced my electrophysiologist to add a left ventricular lead and place a biventricular pacer. Improved my cardiac output 20%.
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My mom needed a pacemaker after her mitral valve replacement in 2005. Hers is biventricular because her heart was not beating in synch. It has helped her tremendously!
 
I had my AVR in 1991. In 2020, my heart rhythm went crazy - three different arrhythmias, all running simultaneously (I wonder if I had asymptomatic COVID-19, and this was a secondary issue).

I got a stent (and am now not sure that I really needed it - my other coronary arteries, based on an angiogram a month ago, showed my coronary arteries were clear and wide open 'like a 20 year old's'.

My arrhythmias didn't resolve to medications. I had two nodes ablated, but one still remained (the doctor didn't want to go through my heart's septum to ablate it). After discharge from the hospital, my heart rate dropped into the mid- to high- 30s.

I got a pacemaker - not the fancy medtronics pacer - at the end of May.

Although it doesn't let my heart rate drop below 70 for long, my current murmur continues to confuse my watch and blood pressure monitors.

But, to get to the point, it took 28 years after AVR until I needed the pacemaker.

AVR and pacemaker are probably weakly related.
 
Aortic valve surgery even TAVR is strongly associated with the development of various degrees of AV node block. Other reasons for irregular sinus rhythm are associated with some heart dysfunction. Other valves may be dysfunctional such as the mitral which can lead to problems with atrial size and function leading to AFIb and possibly other arrhythmias. So it is not that simple. One of the key goals in valve surgery is to keep the heart muscle as normal as possible. So a lot of discussion about when to intervene has to do with that . Even in asymptomatic patients if various tests suggest that the heart muscle may be developing irreversible damage it is time to be proactive.
 
vitdoc said:
Even in asymptomatic patients if various tests suggest
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I am asymptomatic - moderate AVS - although annual check in 3 weeks will tell me more.
My cardiologist just does echocardio, have had stress tests as well - all ok - had angiogram last year - some blockage (50%) on one artery. all others ok on statins 20mg
What other "various tests" should i ask for, I dont want irreversable change
 
EKG and Echo generally will tell you enough . Looking for wall thickness and EKG changes suggesting “strain” on the heart muscle. Also estimates of valve gradients. Also looking at function of other valves. Trends are very helpful.
 
LondonAndy said:
I needed a pacemaker as a direct result of my AVR surgery, 6 years ago. It was inserted a week after the "main event". The risk is low, but given the heart's electrics run close to the valve some damage is possible.

It was a few months later before I even thought about what a pacemaker would mean, and whilst I can no longer go on some roller coasters because of their magnetic brakes, and need to go for annual checks, it has had a minimal effect on my life.
Click to expand...
Any idea how much cost that added to things if uninsured?
 
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