Complete PM removal and reinsertion at a new site

I was at the cardiac surgeon last week. I have been having a lot of problems with pain etc. with my PM since 2006 when I had a new PM and lead put in. At that time I ended up in hospital a month later having my PM and lead repositioned. It has never been the same.

I spoke with teh surgeon who did this an the long and short of it was he wanted me to get a second opinion. He sent me to a cardiac surgeon. I saw him last week.

He suspects that I have a low grade infection going on that is causing me my pain...and well the lead is protruding....he could see if from across his desk.

He is suggesting I have the who thing taken out...completely... PM and all the leads....go on a bout of antibiotics and then he wants to insert a whole new unit.

Here are me questions and concerns. I wanted to know if I was a candidate for lead extraction. It would appear I am....but it will be a little more complicated because two of my leads have been in 17 and 23 years...he is confident he can get all the hardware out....I have to be prepared for the possibility of open heart surgery...which scars me...well that and the .5 - 1% possibility of death.

Next thing is he is suggesting I have my new system implanted in my lower abdomin....kind of like the bikini line area....I asked him about the reprcussions of that....he told me..that because generally this is done on older people who arent as active as I am ...he hasn't heard of any concerns....but then he also admits to the fact that he has only done about 30 of this in the lower abdomin.

Currently my PM is situated on my Right side....that is because I am left handed. So putting it in my left side kind of defeats the purpose....so it would appear that the lower abdomin is the place of choice. I have been searching the internet trying to find sites that talk about that and what have been the pros and cons of implant at that site. I haven't found a good site to give me accruate data.

So question.....do any of you out there have a PM that is implanted in your groin area?

3 Comments

why not left?

by Tracey_E - 2008-10-07 06:10:12

I'm trying to figure out why they can't put it on the left side if you're left handed? I could be way off base but thought they put them on the left because that's where the heart is and it's a shorter distance to run the leads, not because most people are right handed.

Mine is on the left but behind the breast, not under the collarbone where they usually put it. They put it in from the side and it's completely buried, I can barely find it if I poke around looking for it. It doesn't get in my way at all, I do all sorts of sport and backpacking.

Drawbacks

by bobad - 2008-10-07 10:10:44

Sorry to hear you are having problems.

Sometimes a low grade infection by an unusual organism can cause inflammation and site pain. It could take a series of cultures by a real expert to track down the causitive organism, but I think that should be done. Since it's been many years, it's unlikely you have developed an allergy or sensitivity to the materials. Leaking leads can also cause site inflammation and pain, however I would think interrogation would reveal evidence of the leads leaking.

I find it puzzling that your doc wants to implant in the abdomen when you have a new subclavian site available. Even your dominant side is much preferable to abdominal. There must be a reason, such as being on the skinny side.

Since I had a PM under my left collarbone, right collarbone, and now threatening to implant one in my abdomen, I have done some research.

The main things I don't like is the more complex surgery, and the way the leads make a large ascending then descending loop. Perhaps your doc can reassure you that the abdominal site is little more problematic than a subclavian site. Mine hasn't given me comparative statistics yet.

Best of luck, and do keep us up to date!

Clarafication....

by maryanne - 2008-10-08 12:10:36

Thank you all for you input. Just to clarify I was "ASKED" which side I wanted my PM implanted many years ago....being left handed I opted to have mine inplanted in my right....and I don't regret that at all....but I think the surgeon who not only implanted my PM but 4 of my other siblings put them all in their right....and they are Right handed. I think it was a surgeon preference.

As for placing the new one on my left...here is what he told me....one yes I don't have much flesh up there....my PM would most certainly stick out as does my current one...he also felt that (as he anticipates I have an infection) that I would have discomfort on my right and then if I were to have it implanted on my left not only would it be uncomfortable...I am left handed and personally would find it uncomfortable....also there is a possibility that in the not to distance future I will require athroscopic surgery on my Left shoulder....and another thing he said was the cosmetic component...I would have two scares on my chest...which I guess is no big deal...but still something to consider.

He personally has only performed 30 implants in the lower abdomin groin area....he is leaving the choice up to me...hence my question is put out there as I am not finding much information on the internet.

Bobad in answer to you comment about low grade infection....I would agree that it is most probably lead related....no doubt there is something brewing in there...the discomfort is just gradually getting worse....his intent when he takes everything out is to take lots of cultures....I know I will be on antibiotics for a least a few days...he is preparing me for a possible month...which he states I would have to get a PICC line inserted in order to give me my daily dose of antibiotics. He has also prepared me for the possibility of open heart surgery.....so I am not going in there blind. Being a critical care nurse I am fairly familiar with a lot of the procedures....some times that can be detrimental....

Anyhow....that's what I know so far...thank you all for your comments...

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