Pacemaker Lead Replacement

I am a basically healthy 73 year old and have a dual chamber pacemaker on my right side  since I was 35, for sick sinus syndrome.  
My pacemaker batteries last about 8 years and I have had 4 replacements and I still have the original wires.  
I feel fine and my cardiologist had me wear a 30 day event monitor on suspicions that my leads were not working effectively.  There were no critical events except there was a 3 second pause in my heart that shouldn't be since I have a pacemaker.  
The artierial lead is not functioning, however the good news is I don't require that much pacing in the upper chamber.  They recommend I see a specialist for a lead extraction, I am very leary of doing this on 38 year old wires.  I have about 2 years of battery on the current pacemaker and I don't want to make any rush decisions.  I'm thinking of leaving the leads and having them put a new pacer & leads on the left side.  I feel fine so this is a very hard decision to make with such a big procedure on old wires.


14 Comments

old wires

by Tracey_E - 2023-09-08 08:41:11

Wow, that is some seriously amazing lead life!!

I, too, have very old wires. You've got 2 years to do your homework and think about it. 

I had one lead go bad in 2010. I had a venogram- iv with dye done in the cath lab- to see how much space was in the vein. There was plenty, so we capped off the bad lead and added a new one .This is not the preferred way to do it now. Extraction technology has come a long way since then so it's much less risky. But it may be an option if you don't want to extract and the other lead is working well. 

I would start with a consult with someone who specializes in extraction. Depending where you live, this might mean traveling. A specialist can tell you what your risk is and what they recommend. There is even at least one specialist who specializes in high risk extractions. My ep's team does a lot of extractions, but when the time comes he is planning to refer me out to this other doc. 

Moving to the right side might be an option. Leadless is getting more common, so that may be an option also. I thought leadless was not an option with existing traditional leads, however someone on another cardiac list I follow got the first one in UK yesterday! No lead extraction, dual chamber leadless pacing. I see my ep today and that's top of my list of questions, how common is this now and would I be a candidate. I've got one year left on this device. My leads are working well now, but odds of them continuing to work well through another 8-10 years aren't good so we are debating replacing proactively. 

Good luck and please stay in touch!

Old Wires

by Cam - 2023-09-08 09:37:26

Thanks for your suggestions Tracey.  
I am scheduled to see a specialist on November 20, who is well know for lead extractions...I will know more then.  In the meantime I am gathering information for questions to ask when I meet with him.  I'll keep you posted...I'm very reluctant since these leads are very old.  I don't know if there is anyone with leads that long.  
Thanks again you gave me some good questions to ask.
Good luck to you also and I will keep in touch!

 

 

 

My situation is very similar

by Good Dog - 2023-09-08 10:16:59

Hi Cam! I find your post very interesting, because our situations are very similar. My atrial lead is 37 years old and my ventricle lead is 28 years old. The ventricle lead was added in 1995 and the original lead was capped at that time due to the original lead being recalled by Medtronic. 

In any case, both leads are still fully functional, but the sensitivity adjustment of the atrial lead is difficult to adjust optimally. I have only a few months remaining on the generator battery and my EP is recommending extraction and the addition of a third lead to facilitate a CRT. I had a venogram and the vein is occluded so there is no possibility of simply adding another lead. Extraction will provide that option. The one thing that may be different from your situation is that about 2 years ago it was discovered that I have PM syndrome (non-symptomatic) and my ejection fraction dropped to around 40%. So that is the primary reason/rational for a CRT. There is a strong liklihood that a CRT will restore my EF to normal or near normal. 

Like you, I have serious concerns with extraction of my old lead(s). I started seeing an EP at the Cleveland Clinic almost two years ago, but he just left the practice. So I have an appointment with another in a couple of weeks. My previous EP told me he is the best and performs the most which is why I chose him. So I will be discussing my options with him. Believe me, if there is a viable option (alternative) that would preclude the risks of extraction, I will want to pursue it. I doubt that there is, but we wil see and I will keep you posted. At the age of 74 (almost 75) and with the extraction of these old leads looming, I am feeling pretty risk adverse. I think that if I was symptomatic I may feel differently. Of course, the fact that I am not symptomatic today is no guarantee that I won't be in the near future. Wish I had a crystal ball!

In any case; I wish you the best!

Sincerely,

Dave

Old Pacemaker eited

by Cam - 2023-09-08 12:19:03

Hi Dave

im sorry to hear that you have the same issue as me.,,it's a scary procedure especially with the amount of scar tissue after all these years.

I have never had a problem with my heart of any kind other than sick sinus syndrome, which was diagnosed when I was 35.  Until recently there was never an issue with my leads.  Fortunately I have lived a active healthy life and I'm looking to continue with  the things I like to do.

  I haven't met with the surgeon yet to ask all the questions but I do know he performs this surgery and is considered to be one of the best also, he is located in New York.  

im sure you are in good hands at Cleveland Clinic, it's a top rated hospital.

Good luck to you and hopefully we will both have successful outcomes.  Keep me posted 

Regards

Cam


 

Scar tissue

by USMC-Pacer - 2023-09-08 13:35:06

March of this year I had my leads removed @ 10+ years. The EP was very experienced at it and said it wasn't "easy." He was only going to remove 1 defective lead, but ended up removing both as they were "entangled and covered in scar tissue. Thankfully, nowadays they have better views and technology such as lasers to cut though the scar tissue. The surgery went without issues. But, wow I can't imagine how leads will be after all those years. Wishing you prayers and luck.

Old leads

by Cam - 2023-09-08 13:41:07

Thank you for your concern...hopefully all will turn out good.  I still have 2 years on my pacemaker generator so I am doing a lot of research.  I'll keep everyone posted as I move forward with whatever procedure I choose.  Thanks for all your concern and I appreciate your comments.

CRT versus New Physiologic Pacing

by Terry - 2023-09-08 17:53:50

No need to pace the ventricles with a lead passing through the AV valve. See <https://www.his-pacing.org/the-list-his-bundle-pacing-papers/> and scroll down to the list of scientific papers related to CRT.

Update

by Tracey_E - 2023-09-08 18:50:41

I saw my ep today and learned that my 29 year old lead is now showing some minor signs of wear. There have been some very short episodes that the pacer recorded as a few seconds of afib but are actually noise from the old lead. It's nothing urgent and it could stay like this for years without causing problems, but I will definitely be dealing with it at my next replacement (1.2 years est battery life). So that decision was made for me! I was leaning that way anyway. 

I asked about leadless, and he said that will most likely be an option!! I'm otherwise healthy with a good EF so he said we can look into it. He's not a fan of the Medtronic dual chamber pacing because it's two devices (atria and ventricle) which are not intended to be removed. He prefers the Abbott which is one device in the ventricle, and it is designed to be extracted when it is replaced. So given my age (56), at this time he thinks that's a better choice. We have a year or so, so not making any decisions at this time. But I'm very excited that it's even a possibility.

So the next question is, will I leave the leads alone or get them out anyway. They are placing the leadless without doing extraction in patients where extracting would be very risky. We will make a decision when it gets closer, for now it's just something to think about. There are risks/benefits to both. Part of me wants to have the hardware out, part wants to leave well enough alone. 

Update

by Cam - 2023-09-08 23:45:10

I'm glad you got a good report from your ep and you will be a candidate for the wireless pacemaker.  When your time comes to have it replaced in 1.2 years that seems like the best option and if your leads can be left intact without any interference, to the pacemaker that will be a good thing.

Good luck with any decision you make!

 

 

 

 

interference

by Tracey_E - 2023-09-09 12:21:06

He said the old leads won't interfere with the leadless working but it's possible that the old leads and the scar tissue will mean they can't use the most ideal placement and have to place it in a position less than ideal. Removing them won't really change this because removing the leads would still leave the scar tissue. 

I am leaning towards extracting. This week at least lol, who knows where my head will be in a year.

Reasons to do it despite the risks:

I've had some circulation issues with my left arm due to the leads and we discussed having a vascular surgeon take care of that during the same surgery.

The hospital where I would have the surgery has a fancy new laser that has a balloon so that if a bleed starts, the balloon will immediately be used. It's still a serious surgery but this makes it less risky.

Also, we have access to someone who specializes in high risk extraction. He has privileges at my ep's hospital and travels to do high risk extractions with him. If I'm ever going to do it, these two together are the best hands I could ask for. The two of them together have never needed the cardiothoracic surgeon who would be on standby. Not just standby, but in the operating room.

At the very least I will do a consult with both of them as well as an xray with dye/contrast to see the condition of my veins. 

Wireless pacemaker

by Cam - 2023-09-09 15:06:19

I feel your confusion Tracey...every day I have a different feeling also.

I appreciate  your input and I will have more information when I speak to the surgeon in November.  I have been doing some research and I have a lot of questions for him.  I know I have 2 years but that time goes by very fast.  

Right now I'm healthy with no other health issues so I'm thinking I should make a decision while my health is still with me.

I'll keep you posted.

Terry, Tracey & Cam

by Good Dog - 2023-09-10 13:38:09

Terry - I assume that you are referring to LBBP (left bundle branch pacing). That is what my first EP at the Cleveland Clinic proposed for a CRT in my case. I am meeting with my new EP in a couple of weeks and will discuss that with him.

You should know that it had always been my hope that I could have conventional HBP (HIS bundle pacing) so that it would not be necessarry to place another lead through the trisuspid valve. Also, because I have been searching for any option that might preclude the necessity of extraction of my old leads. There are already two leads passing through the valve. Obviously a third could present its own issues. Also, my hope was based upon the assumption that a new lead could be added and extraction of my very old leads could be avoided through the use of HBP. As you know, HBP has been know to remedy HF in many cases. Given that my vein is occluded, extraction is necessary regardless. Also, my cardiologist had informed me that it is not possible to perform HBP with heart block. So it has been a real learning experience for me.

Tracey & Cam - I am meeting with my new EP at the Cleveland Clinic in a couple of weeks and will also discuss the possibility of leadless pacing as an option to avoid extraction. I will let you know what he has to say......

Dave

37 Year Old Leads

by LadyLynda - 2023-11-04 19:41:17

Hi, I'm 54, from the UK, and on my 3rd pacemaker. My first was implanted on 12/12/1986 at Leeds General Infirmary, when I was 17, and lasted nearly 19 years. My 2nd was 06/06/05, lasting nearly 13 years. The 3rd was implanted on 22/01/2018. Both my atrial lead and my ventricle lead are original, fitted in 1986, so they'll be 37 years old this December. 

They are showing some signs of wear, and are regularly checked.

I have had no problems with my leads or devices, until this latest one, fitted in 2018. Every time it works, I feel the small electric pulses, almost like an electric shock, but nothing is wrong with it. It's not painful, just a little annoying. My other two devices weren't anything like this, they almost felt like they weren't there, if you know what I mean? Apart from the great lump and scar that gave it away!

 

37 year old leads

by Cam - 2023-11-05 11:37:18

Hello Lynda

i have my leads in since 6/6/1985.  I am seeing an  EP on the 19th of this month to discuss my options since my lead in the atria is not working properly and the lead in the ventricle is working but showing wear.  I have 2 years left on my pulse generator so I have to see what the EP suggests.  I am concerned about lead extraction because it is a very delicate surgery.  I have no symptoms at all and I feel fine.  In the past the adapted the wires to the new pulse generator.  I will keep you informed  after my visit to the EP.  I would ask your EP about the feelings you are experiencing.  Good luck to you!

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