Extraction or Addition of leads

I was informed that my RV lead has a problem....oversensing noise...which they temporarily adjusted. And it has to be replaced. I was also told my RA lead is drawing more volts: from 2 three years ago to 2.9 now. But the RA lead is working fine now. The RV lead is 8 yrs old, and the other two i have are three years old. 

I was offered two choices: add another RV, or extract and put in all new. The Surgeon recommended extraction because of the RA. He said it would decrease the longevity of the battery which is now 30 percent depleted. 

What are the downsides to simply adding a lead in this case??

I know extraction/replacment, as it is surgery can have serious problems. 

i am concerned about the extraction of my current three leads.

(They dont know what caused the issue....) 

 


10 Comments

Lead replacement

by Good Dog - 2023-02-18 20:26:18

I cerainly understand your concerns. Frankly, you and your leads are young enough that it makes sense to replace them now instead of kicking the can down the road. However, I am in a similar situation, except that my leads are much, much older and I am 8 years older than you. This is a decision that only you can make after a consultation with your Doc. If you decide to have leads extracted, be sure to ask your Doc how many extractions he has done. Inform him that you want someone that has a lot of experience. At lease 50 to 100 extractions is a good number for you to be assured he has sufficient experience. Also, the hospital should be also have at least that number or more. 

If you decide to have the extraction done you can be assured that the results will be very gradifying. You'll have the latest and the greatest completely new system. However, either way, you need to do whatever you feel you will be most comfortable with. Just gather all the necessary info, make the decision and then get on with your life! Really, there is no bad decision, but not having made a decision can be very unsettling. So once you do you will feel a sense of relief. Of course you will be nervous before surgery, but that is normal. Everybody is!

I wish you the very best. Please come back afterwards and let us know how it went!

Sincerely,

Dave

Lead replacement

by Alexanderxyz18 - 2023-02-18 22:04:11

Thank you Dave for your response. 

I was told the surgeon is a specialist in this procedure and the hospital does these kind of extractions twice a week regularly....NYU. They have a 98 percent success rate.......which is about the same success rate listed in several books I found...(Dr Ellenbogen....Cardiac Pacing) 

I have several weeks to decide which way to go and two months from which to select a date. 

I try to look for the least invasive solution...to minimize risk. And, if I can avoid the extraction for several years, I was hoping improvements might offer something better down the road. So, I am leaning towards just adding a lead. If I do a replacemnt the new device will only be three years newer. So, far the only downside I found out was: 1. I have more metal in me if there is an infection 2. If the RA lead needs even more volts...then they may need to address that....but then the device will last less than 9 years. The leads develop precipitant on them which causes the voltage to go up. I dont know if another area of the heart would do any better...presumably they found the best spot three years ago.....so new leads may offer me nothing more....

anyway, 

Good Luck with your procedure when you go through it. And thanks again. 

Lead extraction

by Aberdeen - 2023-02-19 05:14:31

After having bouts of feeling tired, unwell from November '21 I was contacted by the pacemaker clinic in April 22 and informed that my ra and rv leads were failing and draining my battery. I had these leads since January 2020.

I had contacted my doctor and had a echocardiogram in December 21. I have a moderate mitral valve leak so they thought it was the cause. There hadn't been any change since the year before so I decided to try to put up with the bouts of feeling unwell.

In April I had surgery to remove these leads - my left lead was all right. (I have a CRT pacemaker) The surgeon said he would prefer to remove them rather than add new leads.I was also told if I felt unwell to go to the pacemaker clinic first. I have a bedside monitor.

Fortunately the surgery was successful and since then I have felt very well. 
You said that the surgeon is very experienced and the success rate is 98%.
I wish you well whatever you decide. Let us know how you get on.

ALEXANDERXYZ18

by Good Dog - 2023-02-19 08:07:47

I think you are fortunate to have access to such a great hospital. That is really great news! It sounds like you have already made your decision and I cannot argue with your rational. It makes sense to me! As I said; I am in a similar situation; I also believe that the least invasive choice is a good one. Twenty or thirty years from now, I would hope that nobody has to make this decision! In any case, I just want to wish you the very best!

Sincerely,

Dave

Leads continued

by Alexanderxyz18 - 2023-02-19 13:16:32

Thank you, Aberdeen and Dave. 

From what I read, the increased voltage draw has to do with the change in resistance from the material collecting around the leads. However, in the last year I not only regulary do speed walking for over half a mile, but I completed a diet and lost 65 pounds,,,,,,which lowered my blood pressure substantially. .....I was much heavier when they placed the leads....which may not mean anything.... i also have asthma which makes it hard to figure out if I am having issues. ....but i feel much better after exersize. I still have not made up my mind. I will be talking to the surgeon next week to discuss my concerns....I just wish I understood the issue better. Reading an advanced book on pacemakers did not help. Your stories have been helpful . And again thank you. 

leads

by Tracey_E - 2023-02-19 15:50:07

I added a lead rather than extracting in 2010. I stll have one lead from 1994 that is working will for me. The bad lead was capped off. There has been no downside to leaving it there, so far. That said, my leads are a lot older than yours and a lot more complicated to get out. Yours are relatively new and extracting should be easy, esp since it sounds like you have someone highly qualified to do it. If I were in your shoes, I'd probably want to get them out while it's easy and start fresh. 

Just wishing you well!

by Lavender - 2023-02-19 20:27:18

Good that you're educating yourself and exploring options. Always amazes me that we are given choices by the professionals. I guess I would be more comfortable knowing their expert opinion as well as the benefits and risks before moving forward. May God guide you as you make this decision and bring you a sense of peace. 💗

Extraction

by AgentX86 - 2023-02-19 22:02:18

I would definitely go for the extraction.  I'm not one for kicking the can down the road.  I don't think you mentioned anything about a new PM but I would wait until they can do it all together.

Abandoning a lead is not a good idea, IMO.  The days of it being a very risky surgery are in the past.  It still takes a specialist but a noted, it's pretty common now.  In addition, an abandoned lead will almost assuredly disqualify you for an MRI. It's hard enough with a matched setup, mismatched leads and box makes finding someone to doand MRI harder. Dealing with a radiologist, having  an abandoned lead is a lot worse.

You may never know

by Good Dog - 2023-02-20 08:34:11

You may never know why your lead(s) failed. My leads are 36 years old and still functional. I cannot explain it. My doc seemed to indicate that some leads are just more rugged than others. Though as Tracey said; these old leads will be much more risky to remove. I feel that is a good reason in my case to not remove them unless absolutely necessary. Your situation is a different story. It seems like you are doing your homework to the best of your ability. I don't think that reading in an effort to understand more will be of much help at this point. Discussing this with your surgeon should give you the best perspective and the understanding that you need. It should also give you a much greater level of confidence in him as well. That should be very reassuring. So after meeting with him, whatever decision you make will be the right one for you. Once made, it will relieve a lot of the stress. Try your darnedest to maintain a positive attitude. I am confident that all will go well for you!

I wish you the very best! 

Dave

Thank you all

by Alexanderxyz18 - 2023-02-20 16:38:15

I am very glad to have read all your messages. 

Next stop for me is a talk with the extraction surgeon....probably in the next week. I found there are many types of leads, so, I will be asking him about difficulties removing what I have specifically. And also the downside of just adding....as I said...the RV lead is starting to fracture, and the RA lead, while functionally not a problem,  is drawing more voltage than they would like (from 2 volts to almost 3 volts over three years). This is due to changes in the electrophysiology of the implant site. This can happen with any lead. Even the replacements. They want it to be around 1 volt. They are concerned if it suddenly gets worse even though there is no sign of that happening. 

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