Insulation break of lead & antibacterial envelope


i Recently underwent my 5th generator change.

this one was different in so many ways:

1. My pacemaker went into battery power save mode: this is terrible! I started feeling crappy on a Friday and come Monday I got a call from the doctors that my pacemaker changed into this mode on Friday.

2. I then had an urgent generator change on Tuesday (the following day from finding out about the battery save mode being on) By urgent I showed up at 11:30am (as told too) but didn't get taken into the ER until 6pm! Ugh it was a loooong day.

3. I specifically asked the EP/Surgeon for the antibacterial envelope to be used ; has anyone had one of these? Since each generator change you are at higher risk of an infection.

well I just got the procedure notes and found NO mention of the antibacterial envelope used. What would you do/say? I know nothing can change now... but it's so frustrating.

4. I also saw via the procedure notes: "Upon explanation of the device, the right atrial (RA) and right ventricular (RV) leads were disconnected from the device header and visually assessed for damage. There was mild insulation break on the atrial lead, and this was repaired by placing a suture sleeve over the damaged area and securing it to the lead"

any experience or knowledge of this? I'm a bit surprised and upset the doctor made no mention of this to me post procedure. My one week follow up was with a nurse (I was expecting it to be with the Doctor)

5. Then I had a neurotoxic reaction to the antibiotics they put me on post procedure. Wound up in the ER they tho it he I had a stroke due to my symptoms (slurred speech, trouble finding correct words when speaking, feeling very drugged, fuzzy headed, nauseous, just really out of it) 


this was a rough on for me and just a generator change... makes me nervous about this doctor being the person who may have to extrac four leads in the future (2 are 25 years old) and the 2 functional ones (one of which has "minor" damage now) are 15 years old.

the health industry is really having a hard time providing the type of care patients need and deserve. 



by piglet22 - 2023-10-20 06:52:11

Thanks for relating your experiences.

You have had a lot done while relatively young.

I can share the low battery voltage mode change experience as mine did the same in 2016. It certainly spoils your day and you wonder what the hell is going on.

I was curious to see how your doctor was alerted to call you.

I presume the device that failed was the 2016 implant.

Did that have Bluetooth, and did you have any sort of home monitoring?

Certainly, my Medtronic Ensura of that vintage didn't have that facility and although I have a monitor now, I don't think it's capable of sending out alerts and I physically have to place the reader over my PM and initiate a transmission.

I can't really comment on the infection prevention but it doesn't surprise me that it's not mentioned. Medics can be a bit dismissive.

It's worrying to read about the lead damage and the in-situ repair job.

The insulation layer is meant to insulate electrically and provide physical protection against moisture etc.

A suture sleeve sounds like wrapping a plastic bag around a leaking hose. There are repair materials for that sort of damage, and one that comes to mind is heat shrink sleeving but is maybe not the sort of thing you find in theatres.

I was prompted to have a read of some of the manuals for the Adapta and mind-boggling is an understatement. How any one person can get their head round that lot is beyond me.

If you think your healthcare system is having a hard time, then I can tell you that the UK NHS isn't much better.

Best wishes


by Amyelynn - 2023-10-20 12:01:24

My pacemaker which went into the battery save mode was the 2016 Adapta device. The alert that was sent was because I did a Manuel at home transmission on Friday (they didn't receive in until Monday due to the time) then they called.

so I guess it's good to know if your ever feeling really bad/weird a transmission may tell them something.

I believe now I have the attesta model. I never knew that the pacemakers come in 3 categories: small, medium, large. The Medtronic guy who came the day of the procedure brought two models for me a small and a large. The only difference was longer battery life in the large (wish I asked the difference) with all the smalls and mediums I've had over the years it's always lasted me 7 years (unless cut short due to the leads failing) I opted for the small device. Can't imagine something larger at this point of my life when I'm extremely active and the placement gets a bit in the way with activities & sleeping.

the fix for the leads I read about in one study... but it seems it's not studied a lot. However the doctors only other option would be to remove that one lead while not damaging the other functioning lead or remove all four leads (the two abandoned) plus two functioning ones. I bet he didn't want to do either given his loooong day and from what I read from the little study they didn't see a difference in fixing the lead or placing a new one 🤔 not sure really...

I just really wish it was discussed with me at the follow up visit with the surgeon. I'm curious as the exactly where the insulation damage is (is it due to a lot of arm movement, the pacemaker, rubbing against the other leads etc) and are they concerned about more damage anywhere else on that or the other lead... since they didn't seem to see the issue via interrogations. From what I read fluroscopy is best for detecting lead damage.

it's been a rough year with the svc syndrome, angioplasty, and now this unplanned procedure. Happy everything is ok for now... but I just worry about the whole kicking the can down the road affect.

sorry to hear the medical system doesn't seem that much better in the UK. I thought it was 😭

Anti bacterial envelope

by Aberdeen - 2023-10-22 17:53:56

I had RA and RV lead failure 2 years after having a CRT pacemaker implanted . As the pacemaker had to be taken out temporarily they replaced it in an anti bacterial envelope. I believe it costs quite a lot but is effective in high risk patients. I have had 3 pacemaker operations since January 2020. I am in Scotland so this was done on the NHS.

You know you're wired when...

You have rhythm.

Member Quotes

Yesterday I moved to a new place in my mind and realized how bad I felt 'before' and the difference my pacemaker has made.