Sensation of leads inside of heart, is this even possible?

Hello everyone,

I've just joined this club (online and by having a pacemaker fitted for the first time yesterday). The recovery is going as expected, pain/pressure at the site of the pacemaker, and I'm super careful about not lifting my left arm etc.

A few times though I've had the sensation of a small twitch in the centre of my chest that is in line with my heart beat - either just a one off as I change position or sometimes a few times in a row with my beats. I'm honestly wondering if I'm just imagining these sensations as I know there's something new there but - is it at all possible that you feel the leads move inside the heart? Has anyone experienced anything like it?


6 Comments

pacemaker

by new to pace.... - 2023-07-07 05:34:04

It would help if you filled in your bio  esp. with the make, model, where you live.  As the answers sometimes depend on where you live or the type, brand model.

new to pace

Ventricular pacing

by Penguin - 2023-07-07 06:34:24

Hi John, 

....and welcome from me. 

The sensation you describe sounds very much like ventricular pacing.  I may be wrong but if that's what it is it feels (to me at least) like a slight prickling or trickling sensation - sometimes a one off, but often in a row. It doesn't sound as if it's lead related to me, but others may disagree.  

(Btw it's perfectly normal to worry about leads moving - everyone does!! - but it rarely happens.)

You don't say whether or not you have AV node conduction issues which require ventricular pacing   If you do, you may continue to feel these sensations when the ventricle is paced.

If you don't have AV conduction issues you may still feel and receive v.pacing immediately after an implant because the procedure itself can create electrical disturbances to your heart rhythm which can take a little time to settle and which may prompt ventricular pacing. 

I hope this helps a little and that this explains what you you may be feeling.  For confirmation you could keep a note of the dates / times that it happens and then when you go into the pacing clinic for your post-operative checks ask them to have a look and see whether you were v.paced at those times. 

I hope this helps a little. 

Welcome to the Club

by Gemita - 2023-07-07 06:43:17

Hello John, firstly welcome to the Pacemaker Club.  You are certainly not imagining what you feel.  

I remember those small twitches well.  My sensations felt like electric shocks in my upper chest often radiating to my upper back and it was most unpleasant.  Some experience ant bite sensations.  Some have pressure pain in their blood vessels that have been traumatised during lead placement.  Other members notice twitching and pulling around their devices as the pocket and wound heal.  

One other possibility is that twitching can be caused by lead settings being set slightly higher while healing is taking place.  Once these settings are reduced in clinic at around 3 months (or earlier if necessary) you may no longer feel any diaphramatic/chest wall twitching.  You could also ask whether your paced/sensed "polarity" is set unipolar or bipolar.  Unipolar may cause "twitching".

Most of these sensations and many more can be normal as we heal depending on whether we had any surgical complications like blood vessel trauma during lead placement, nerve, muscle, tissue trauma and irritation.  It will also depend on the expertise of the surgeon doing the implant.  

Remember lead tips are attached to delicate heart tissue and these should stay in place if they have been well positioned by a competent surgeon.  At the other end of the leads where they are attached to your device, they always leave some slack so that movement is possible, so it will not be easy to pull on your leads.  I think you would know from worsening symptoms in any event if your leads tips became detached from your heart at the start of pacing since you would notice pre pacemaker symptoms again.

I hope you recover well and start to see real benefits from your pacemaker.  Please contact your doctors though if you have discomfort that is difficult to tolerate since they may be able to help or to reassure you at this early stage of your pacemaker journey.

Thank you Penguin!

by John_Locke - 2023-07-07 07:52:13

Thank you Penguin (and everyone else who replied), this actually makes a lot of sense and makes me feel a lot better.

I have an infrequent AV block that was picked up in my early 20s and has been under monitoring. I'm now in my 40s - no episodes of fainting but they've picked up some longer episodes of AV block moving into complete heart block so the recommendtation was that now is the time to do something about it, so - a dual chamber pacemeker it is (though a leadless was also discussed).

I didn't expect it to actually kick in as the doctor who performed the procedure said that he'd set it to keep a min heart rate of 40 and not do any work otherwise to preserve battery. It does make sense though if this was ventricular pacing kicking in when the AV node hasn't conducted as it should, sometimes just the occasional one and sometimes a few in a row.

I'm surprised TBH that there's no information given about this sort of thing. All official sources I've seen say that "You can't typically feel the electric shock", but nothing about the sensation from the heart muscle in response to it.

I was also not told about the potential of short term effects on the electrical system after the procedure. I have noticed ectopic beats since the procedure (though of course it's only been a day and a lot of other things like stress/lack of sleep over the last few days may play a part as well).

Almost impossible to feel

by crustyg - 2023-07-07 15:46:35

To my lasting embarassment I thought that I'd dislodged a lead about 7weeks into my PM (ended up in cardiac ICU for a night due to a raised troponin- sigh!), and I had a lovely chat to the very experienced EP-tech they called in to check my PM.  He told me that in 20+years of practise, he'd only seen one patient who could genuinely feel a dislodged lead in the heart.  Turned out what I was feeling was twinges from my PM pocket.

Don't misunderstand me, the inside of the heart has plenty of nerve endings - another chum started out in his ablation with only local anaesthetic, and after the first blast of diathermy realised that every burn would feel like a heart attack => plenty of sedation thereafter.

In medical practice you soon learn that there is no 'Never' or 'Always', but some things are extremely rare, and feeling your leads inside the heart (as opposed to feeling the pacing pulses) is really rare.

ablation with only local anaesthetic

by AgentX86 - 2023-07-07 19:30:57

Three of my four (including AV ablation) were done with only locals.  One, as crusty says, was pretty bad.  It felt like they were driving a hot soldering iron into my back.  The other two were no problem at all.  Didn't feel a thing.

For the fourth (second of the four), I was sedated but not deeply. Not deeply enough, anyway. They cardioverted me when I was aware of what was happening.  I was listening to the conversation but not thinking that they'd actually pull the trigger before giving me more happy-juice, or something. Zap! Damn! That hurt! The nurse said that I shouldn't have remembered it, if I did feel it.  Well, if I didn't, how am I able to say something now?

A simular thing happened during my wrist surgery.  I couldn't feel a thing (nerve block and sedation) but I could hear and understand what was going on.  After, the nurse said that I couldn't possibly be remembering anything.  I told her what the surgeons ordered for lunch. "Oh."

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