So for the record, what he is suggesting is a CRT-D (Cardiac Resynchronization Therapy Defibrillator) also known as a bi-ventricular defibrillator or three lead defibrillator. They have a pacemaker built in. So to your question...you have three options to consider. First if you get the CRT-D they can always switch off the defibrillator function and use just the pacemaker to synchronize your ventricles. Second you can just insist on a CRT-P which is a pacemaker only, or you can outright refuse any or all.

So you understand that you need the pacemaker function for your out of synch beats. It gets rather complex but basically if your QRS duration is greater than 50ms if should help significantly and make you feel better...no guarantee as there are other factors that can contribute, but a good chance.

Now as for the defibrillator function, it gets complex. First is the shock, which I lovingly refer to as a Jesus Jolt, because when it hits I shout Jesus then it's over. Really no big deal. It feels like a thump to the heart but is only a split second in duration and then it's over and no biggie. Because your Ejection Fraction is below 30% you are at higher risk of SCA (sudden cardiac arrest) and the defibrillator will help protect against that. Less than 25% of people who experience SCA survive without a defibrillator.

Another feature of the defibrillator portion of the device is called ATP (Anti-Tachycardia Pacing) it's for when your ventricles go into tachycardia (fast heart beats) and can run out of control causing Fibrillation which can lead to SCA. It basically overdrives the heart beat then stops and the heart goes back into a natural rhythm. If you go strictly with a pacemaker these two features are not available to you.

I have had a CRT-D for 10 years and am paced 100%. Had my share of Jesus Jolts and can't even begin to count the times I've had ATP therapy and can honestly say it's no big deal. Most people never experience a jolt it's just a safety feature but if you need it, you'll be glad you have it.

I don't know your reasons for not wanting the defibrillator, and certainly that is your decision to make, but I assure you that the vast majority of people who have one consider it their pocket protector and it's no big deal.

Good luck whatever you decide. And any further questions ask away.

I too am 62yrs old.. I have had a pacemaker/defibrillator for 7 years, ago left bundle block and CHF last ef was 15/20. However if I didn't have the defibrillator, I would have died several times. Don't turn it down. It could save your life. Hope this helps.

Wow. Thank you so much to both of you for replying. A lot of information and alot to help me think about. I will tell you that I have such anxiety over getting shocked that the thought of it depresses me. I am a critical care nurse and I have taken care of quite a few patients with stories to tell that did give me pause regarding the defib part. I am going to the EP doc on April 19th and will hear what he has to say. Again, thank you both tons.

Interesting, as a volunteer for Mended Hearts I've met many medical personnel who received or were about to receive a defibrillator and most were more frightened than other patients.

As a critical care nurse, I'm sure you realize that patients don't all react the same to pain and similar stimuli. Let's face it, a lot of people become drama queens when it comes to health issues and a little scratch becomes the end of the world. I promise that there are many patients besides myself that feel a shock isn't what it's cracked up to be. The jolt is instantaneous and is over, in fact I wouldn't describe it as painful, but rather just a quick hard thump and done. It startles you more than anything, and in some situations you'd be unconscious before the jolt. I usually have some residual effects for a few hours which is like a muscle ache. Just reminds me I'm alive, not to mention I learned to dance the macarena by being jolted.

More important, most patients with a defibrillator never ever receive a shock but it's there in case.

Good luck to you whatever you ultimately decide.