Been optimized? What do they do?

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Mary Kay
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Joined: September 23rd, 2011, 10:57 am
Location: Oak View, CA

Been optimized? What do they do?

Post by Mary Kay » October 30th, 2011, 4:23 pm

I found out that there is a proceedure called optimizing or optimization that takes about an hour and requires the surgeon, the St. Jude tech and the cardio tech to all be together to work on optimizing the settings on my bi vent icd. I was told it takes about an hour. I tried googling it but couldn't find anything that explains what they do to the patient. Who can share if you have had this done? What should I expect?
I will, of course ask my doctor but I won't see him again for a month.
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

TravelingMan
Posts: 817
Joined: December 19th, 2005, 8:12 am

Re: Been optimized? What do they do?

Post by TravelingMan » October 30th, 2011, 9:06 pm

I'm supposed to have it done in about two months. I upgraded to a BiV in mid-September and the EP said about three months for the optimization. As I understand it, my EP and Cardiologist, the Medtronic (in my case) tech will watch an Echocardiogram and adjust the settings on the BiV to get maximum ejection fraction. Biventricular pacemakers are usually programmed with the default setting of synchronous biventricular pacing, although the ventricles may be paced sequentially.Optimization determines whether syncrhronous pacing or sequential is better. I never thought I felt bad before but I'm really surprised by how much better I feel after getting the BiV so I'm looking forward to optimization.

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mrag
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Re: Been optimized? What do they do?

Post by mrag » October 30th, 2011, 11:38 pm

I asked about this "AV optimization" a few months ago on here and another forum. I never got to speak to someone that had the procedure. I was supposed to have it done, but since I've felt 'good' decided to skip it. If it ain't broke, don't mess with it. My EP also said if I felt good, he did not see many advantages. I would be very interested to hear anyone that has had the procedure done-it is supposedly pain free, short and simple.

That thread and very good info (as always) from Flying Camel can be found at:
viewtopic.php?f=24&t=8632&hilit=AV+optimization
nonsense area-does anyone even read this area any more

Mary Kay
Posts: 1475
Joined: September 23rd, 2011, 10:57 am
Location: Oak View, CA

Re: Been optimized? What do they do?

Post by Mary Kay » October 31st, 2011, 12:35 am

So it sounds like travelingman has been told what I have been. My ef is 35 and they want it higher of course. They did an extensive echo hoping the ef had improved, but it hadn't, they think my heart shrunk in size a smidgen, but my other cardiologist did the last echo so they can't be sure until they actually see that echo for comparison. They explained that this proceedure should help improve the ef. Thanks for your replies. I was glad to hear that it is supposed to be painless. They did tell me there is a quick opt. and the full opt. If I do this, it will be the full one or nothing. You've given me info for questions for my doctor about the proof of effectiveness of this proceedure before I agree to do it. So, unless we hear from someone within the next month who has actually done this and/or really knows for sure the value of doing it, I'll be happy to share what happens.
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

Tony Folkes
Posts: 32
Joined: May 15th, 2009, 9:58 am
Location: Kempston Bedford England

Re: Been optimized? What do they do?

Post by Tony Folkes » November 19th, 2011, 8:25 am

Hi Mary

I am now 73 yrs old. I am English and live in Bedford UK I had my ICD implant July 2008. ( St. Jude Boston Scientific ICD) I was asked if I would like to join a research program called Optimisation for patients with ICD. This is to try to of benifit for patients with ICDs. Absolutly nothing to be apprehensive or worry about I was told. I would be given the results of the research. (That has not happenned yet)

Waiting for my first appointment with the research doctor and soon after the inplant the ICD fired off. I am a smoker (Sadly) and smoke a pipe which I have done since I was 7 years old. Yes 7 years old. That is another story as to how this came about. Nothing to be proud of but as I said I have got to 73 so far. When the ICD fired I was sitting at the kitchen table, I was filling my pipe.
My right hand hammerd down onto the table and left hand swung round sending everything flying of the table. It was just like an electric shock off a car spark plug lead. I have had many of these being a petrol head. It was quite funny really. My wife exclaimed "What the **** was that" she said she heard a crack or something simmilar. We phoned the doctor who was to do the optimisation, he got me in for an interogation straight away. Result was that the thing was just fitted without any particular adjustment and turned out that it really did need to be fine tuned. Some what like the fine tunning or best setting possible on a cars engine to get the optimum performance possible.

It turned out that the reasearch doctor had got a slot he could fit me in to actually do the optimisation and the Boston Tec. would be present. I was wired up similar to a cardiogram and they just played with the settings with the aid of the computer and software. Apart from being on a bed while they played for about maybe 2hours I felt absolutly nothing. Lots of chat and banter.

I went for my 6 monthly interogation last week (all behaving OK) I asked about the Optimisation research results and was told the program had now been completed using a very large number of ICD patience and was very sucessful. Th research doctor was now on a lecture tour of America and other countries as a result of his research. You might have heard of him Dr. Kahan from Addenbooks hospital Cambridge UK.

Mary there is absolutly no problem with the optimisation. My thing has not gone off since. I recommend you have it done if it is suggested or offered.

Love you all Tony

Mary Kay
Posts: 1475
Joined: September 23rd, 2011, 10:57 am
Location: Oak View, CA

Re: Been optimized? What do they do?

Post by Mary Kay » November 19th, 2011, 4:14 pm

Hi Tony,
Thank you very much for the info. I am interested in hearing the results of the study. I'll google the doctor. Since my last post on this I did manage to find a little more on the Google, but it was from 2009. I found 2 things; the opinions regarding the value doing an optimization are mixed and that it is all about adjusting the difib to the best setting for the individual's condition. I thought it included the setting for the pacemaker also, but apparently it is to determine the best settings for the ICD to decide when to defib. I will probably be doing this in the next month or so. They also decided that I need a sleep apnea test because of some of the readings they got when I was sleeping. The sleep apnea studies seem to be the latest fad in medicine and money maker for the people who do the studies and sell the machines. I know a lot of people who have been tested and have the device. One woman told me she never slept so well. Other opinions not so definite. And there was actually one who said she was told she doesn't have it, she just snores a lot. After it is all done, I will post the results of it all.
I am on a much needed break from school this week for Thanksgiving. I had lots of very brief light headed episodes the last few days. It was report card and parent conference week for 30 students. Worked from 7:30 AM to 6:00PM Thurs and Fri. I am looking forward to relaxing.
Mary Kay
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

TravelingMan
Posts: 817
Joined: December 19th, 2005, 8:12 am

Re: Been optimized? What do they do?

Post by TravelingMan » November 19th, 2011, 5:39 pm

Had my optimization done yesterday. I received a new BiVentricular ICD in mid-September. Nothing to it. Basically an echocardiogram with the Medtronic Rep present to optimize the settings on the ICD. My understanding of this is, the BiV has leads in both ventricles now, (they added the third lead when the BiV was installed). With leads in both ventricles the ventricles can be better controlled to maximize the flow rate or ejection fraction thru the heart. From talking to the rep and the echo technician yesterday some people need more adjustment and subsequently get more noticeable improvement than others. My adjustment was pretty minor. They adjusted the beat of the top of the ventricle by nine milliseconds. I can't tell any difference which I'm happy with because that means the settings were pretty optimized on implant. I thought I felt pretty good before the third lead and BiV implant but I can tell a noticeable difference since implant-well worth having done.

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mrag
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Re: Been optimized? What do they do?

Post by mrag » November 19th, 2011, 6:14 pm

Mary Kay wrote:thought it included the setting for the pacemaker also, but apparently it is to determine the best settings for the ICD to decide when to defib.
That is not my understanding. The "AV Optimization" procedure as told to me, is simply to fine tune the synchronization between upper and lower chambers-that they beat at optimum time for each other. In fact, I understand 'optimization' has nothing to do with adjusting the best settings to avoid defib. I would have just about any procedure done if it would minimize my chance of being shocked. I think we need to find out the exact answer on what is being "optimized."
TravelingMan wrote:I thought I felt pretty good before the third lead and BiV implant but I can tell a noticeable difference since implant-well worth having done.
For clarification, the "noticeable difference" was in having the CRT/BiVen implant and NOT in reference to the optimization. I think that is what was said, but I want to make sure I understand.

My question would be, for anyone having had this "AV Optimization," is there any definitive result that you can report (like has your EF increased)?
be the latest fad in medicine and money maker for the people who do the studies and sell the machines.
I am concerned that this optimization procedure falls into this category and despite the rising popularity of BiVen/CRT's, that I can find no first person accounts of results following 'optimization.'
nonsense area-does anyone even read this area any more

Tony Folkes
Posts: 32
Joined: May 15th, 2009, 9:58 am
Location: Kempston Bedford England

Re: Been optimized? What do they do?

Post by Tony Folkes » November 19th, 2011, 7:43 pm

Hi you Guys.

To be honest I really did not realise there were so many aspects to this optimisation business.

I will contact Dr. Faha Kahan's department and see if I can get the full lowdown on each aspect that is raised here. However I am of the firm belief that what ever is optimised and thus giving the best performance for the ICD is of unquestionable value and should be done as a matter of course when the gadget is fitted.

I was given to understand that when my ICD was inplanted it only had the standard manufacture's setting. If it had been optimised there is a distinct possibility it would not have fired off. Like I said it has behaved itself ever since.

Any way the procedure is not invasive, does not hurt and does take anything up to 2 hours(in my case) to adjust. They do compaire and try various settings before finnaly locking it down

Obviously from what I read here you, including myself have had the ICD fitted because if your own individual cases. Mine was because of Arterial Fibrilation and for Bivetricular pacing.

As for being constantly tired I have suffered with this all of my life. I put this down to being of a lazy disposition and could overcome this with exersise and state of mind instead of constantly feeling sorry for myself.

If I can get anything on this I will let you all known. (results of research program).

Regards to all

Tony

Mary Kay
Posts: 1475
Joined: September 23rd, 2011, 10:57 am
Location: Oak View, CA

Re: Been optimized? What do they do?

Post by Mary Kay » November 20th, 2011, 8:23 pm

[quote="TravelingMan"]Had my optimization done yesterday. I received a new BiVentricular ICD in mid-September. Nothing to it. Basically an echocardiogram with the Medtronic Rep present to optimize the settings on the ICD. My understanding of this is, the BiV has leads in both ventricles now, (they added the third lead when the BiV was installed). With leads in both ventricles the ventricles can be better controlled to maximize the flow rate or ejection fraction thru the heart.
Thank you for the info. Too much g :shock: :shock: gling and got myself confused. :runaway: . What you explained is what I originally thought was they reason for doing it. The reason for my bivent sounds simular to Tony's except it came out of the blue. My ef was as low as 25, went up to 35 before the implant and the first month or so after the implant it was still 35. They seemed disappointed and that was when the optimization came up. I agree that any little bit that helps with the ef is worth a try. Thank you for the reasurrance about the proceedure itself. The doctor is also trying to get the Carvedilol dosage up, but since I already have normal to low blood pressure it is a slow go. I'm half way to full dose.
Happy Thanksgiving to all my fellow Yanks.
Mary Kay
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

TravelingMan
Posts: 817
Joined: December 19th, 2005, 8:12 am

Re: Been optimized? What do they do?

Post by TravelingMan » November 20th, 2011, 10:06 pm

TravelingMan wrote:
I thought I felt pretty good before the third lead and BiV implant but I can tell a noticeable difference since implant-well worth having done.
For clarification, the "noticeable difference" was in having the CRT/BiVen implant and NOT in reference to the optimization. I think that is what was said, but I want to make sure I understand.



Al-The noticeable difference was the CRT/BiVen implant. My optimization was one very minor adjustment-changed the upper beat by nine milliseconds. I haven't noticed any difference so far and don't expect to with such a minor adjustment. From talking to the Medtronic rep and echo tech when I had this done my understanding is under ideal circumstances all the settings are optimized at implant. Real world this is still a combination of art,science and somebody's best judgement so the optimization at three months is an adjustment if something has changed or a setting can be adjusted to give a better result. I look at it like putting a new carbereutor on an engine. It may work perfectly right out of the box or it may have to be adjusted after it's been driven for a few miles.

My question would be, for anyone having had this "AV Optimization," is there any definitive result that you can report (like has your EF increased)?
I can't answer that because I don't keep up with EF numbers. Everybody seems to have a different opinion so I just go by how I feel. As long as I can walk five miles in under an hour and 20 in hilly terrani, without being short of breath, I figure I'm OK.

Quote:
be the latest fad in medicine and money maker for the people who do the studies and sell the machines.
I am concerned that this optimization procedure falls into this category and despite the rising popularity of BiVen/CRT's, that I can find no first person accounts of results following 'optimization.'

Best case scenario-you're BiV settings are optimized on implant and nothing changes. In this case optimization is somehwat of a waste except that there is no way to know that beforehand so you have to do optimization to find out you're settings are great.

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mrag
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Re: Been optimized? What do they do?

Post by mrag » January 22nd, 2012, 12:53 pm

Rather than start over, I am resurrecting this thread as I am still looking for others that can give a thumbs up/thumbs down on this relatively 'easy' procedure.

(For those not interested in reading the earlier responses-"AV Optimization" supposedly better synchronizes the upper and lower chambers of the heart so they work more efficiently. This can only be done with the CRT-d (Bi Ven) devices a few months after implant. Scientific research to date has been kind of confusing-some like, some don't.)
nonsense area-does anyone even read this area any more

TravelingMan
Posts: 817
Joined: December 19th, 2005, 8:12 am

Re: Been optimized? What do they do?

Post by TravelingMan » January 22nd, 2012, 2:57 pm

I had my optimization in November. Definitely give it a thumbs up. It's an echo cardiogram with the echo tech and Medtronic Rep (for me) making adjustments. No discomfort. Worst part is pulling the electrode patches off. Saw my EP's Nurse Practitioner this week and she said they will want to do another optimization at one year. The reason she gave is the heart, like any other muscle, changes. In my case the ventricles were not in exact sync prior to the BiV implant. With the third lead from the BiV they are giving me a better ejection fraction, etc. At implant the BiV was set to get optimal output at that time. The optimization gives your heart a month or so to adjust to the new therapies and optimization makes any adjustments (which should be minor). Re-optimization a year later adjusts the BiV to any changes in your heart. Look at it like going from being a couch potato to starting a walking/exercise program. Your working your muscles more so they are getting firmer, you're losing weight, waist size is going down. You have to adjust your pants size or you spend your time at the gym pulling up your pants. That's all optimization is-it's making the adjustments necessary to keep your heart performing at 100% of it's optimal performance rather than say 98%. I haven't noticed any before/after differences and shouldn't. However, in a visit with my cardiologist this week, not the EP, the cardiologist said I would continue to see improvement over the next year. For me, it's like running preventive maintenance on a machine. May not keep it from breaking but if you don't it will definitely break and certainly won't last as long.

Mary Kay
Posts: 1475
Joined: September 23rd, 2011, 10:57 am
Location: Oak View, CA

Re: Been optimized? What do they do?

Post by Mary Kay » January 23rd, 2012, 8:30 pm

I think I posted that original question. I got optimized a couple of weeks ago. I had a talk with my EP telling him that I didn't find anything on the internet that said much to support doing it. I read that it was expensive, time consuming with little proof of much effect. I did read one report that said they got a little better response from women. My ep said it wasn't that expensive, doesn't take long and that he does a lot of them and thinks they are worth it but he wasn't going to tell me what to do. I decided since my ef was still only 35 I was willing to try it even if it only helped a bit. The bivent icd helps a little, the medicine helps a little, exercise and loosing weight helps. So no one thing, in my case is going to bring my ef up to were it needs to be. I have to work on all of it. The exercise part has been the hardest for me. And I have reached a plateau with loosing weight. So, that is what I am trying to work on, loosing more weight and a steady exercise plan. I will let you all know the next time I get an echo done to see how my ef is. i guess if it improves there won't be any way to determine exactly what did it. I just hopes it goes up. Ironically, a woman whom I worked with at a gym 5 years ago called me because she is starting her own business as a personal trainer. I can't anywhere near afford a personal trainer, but hopefully she will have small group classes that I can go to. She was really good.
That was probably way TMI.
smileyquoteunquote
Mary Kay
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

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