2nd surgery for wrongly placed lead wire??

Is 2nd Surgery nec to correct lead wire prob?
Comment posted by kubie on 2010-01-05 18:35.
My husband had emergency Surgery on Nov. 8th, 2009 when his PM was first implanted. We were "out of network" for the surgery, as this was determined to be an emergency. He is 66 yrs old & generally in good health. He had suffered from syncope & dizziness for several months & had a gazillion heart tests prior to his PM implant.

Anyway, DH had a Right Branch Bundle Block. His PM has two lead wires, if I understood both MD & PM Technician correctly. One is called an arterial lead & the other a ventricle lead. The arterial lead appears to be ok & properly placed.

The ventricle lead wire was not properly placed to begin with. The reading on this lead wire was supposed to be from 3 to 8. DH was told his reading immediately after surgery was 1.2 - 1.9. This was still within acceptable range, he was told by both the surgeon & technician.

By the time we left the hospital, it was reading 1.5. It was reading 1.2 when DH had his 1st appointment with the cardiologist & technician three weeks after the surgery. It was reading only 1 when DH had his one month appointment (which actually was almost two months after the surgery).

The surgeon told us he made a professional decision NOT to correct his error (my words, not his) at the time of the original surgery. He did not inform us of a problem at that time & let us make our own decisions, btw. I would have been inclined to fix the problem immediately or as close to immediate as possible, had I been asked for a decision while DH was "still under."

DH has a St. Jude PM with Medtronic lead wires. Is Medtronic still having trouble with its lead wires?? If so, why would the surgeon choose these over St. Jude lead wires for the St. Jude device??

IS this typical for the Medtronic lead wires?? Is this 2nd surgery necessary? Should the 1st surgeon correct his problem?? Should we go to University Hospital (DH's insurance network) & have the 2nd surgeon correct the problem of the1st surgeon??

Are we being bounced around -- because of the insurance network issue?? Prior to surgery, we raised these questions, but could not get anyone to talk to us about this insurance network issue -- DH's primary care MD was conveniently "out of town", his insurance network cardiologist only works on weekdays (this was a weekend), etc, & didn't return our request for a "personal consultation call" before we decided to do the PM with the local cardiologist who is "out of network".

The surgeon is very pleasant & always full of smiles & "don't worry" about the ins network comments. However, I am convinced this original surgeon is stonewalling us, as he gives a 90 day guarantee on his work (weird for a medical procedure, I think). He appears to be trying to get us past the 90 day mark before he makes a decision to correct HIS original error. Then the PM fix will have to be done at another location by another surgeon. Convenient that then both surgeons will actually collect $$$ from the insurance company!!!

Should we contact Cleveland Clinic for advice?? Should we trust DH's original surgeon?? (already I have major doubts about his qualifications AND his integrity re the original surgery & the repair which should have been done immediately, I believe -- which I mentioned before DH was dismissed from the hospital.)

Please share your personal experiences & knowledge on “corrective surgery” for improperly placed lead wires so soon after the original PM implant.

What exactly are the heart & PM problems DH will face with a poorly wired PM should the original (& network” MD, too) MD determine not to do a 2nd surgery (which he has been inclined to do so far).

Thanks for any help & words of wisdom from all of you out there.

Looking for online MD eval
Comment posted by kubie on 2010-01-05 18:37.
Where can I get FREE info & eval of all local MDs, incl cardiologists, surgeons, etc??

3 Comments

leads

by Tracey_E - 2010-01-05 07:01:50

It's not all that uncommon for leads to move out of place. Most displacement happens in the first 24 hrs but it can happen for up to 6 weeks, rarely as much as a year later. It takes time for scar tissue to build up around the lead and anchor it in place.

Most of the time it doesn't mean an error was made if a lead moves or won't stay in position. Considering they closed him up knowing it wasn't exactly where they wanted it, it sounds to me like it wouldn't stay in place. Leads are placed remotely and they watch what they're doing via xray. The heart is beating and moving the whole time, it's amazing to me that they ever get it right! Sometimes they get it in place but the heart beats and it wiggles out of place. Sometimes the heart wall just won't hold the lead tightly. It's not common but it happens often enough that I wouldn't say it's rare.

I'm not a doctor, but my opinion is it was best to try to avoid the second surgery and see if it works as it is. Just because it's not perfect doesn't mean it's not doing its job. If the heart is getting the signal to beat and the lead is reporting back to the pm, that's all he needs and the lead is doing its job.

If it's working now, there are no problems he will face due to the positioning of the lead. Worse case, if they have to crank up the juice on it to get the signal through the battery may go faster than expected. When it's time to have it replaced he can decide to keep the lead or replace it at that time.

To the best of my knowledge, there are no current Medtronic recalls on leads. The recalls were several years ago. Sometimes they mix and match manufacturers, I have no idea why but I've heard of it before.

I would get a second opinion in network and let the insurance co decide if they want to pay again, assuming it needs to be repositioned. If it's working, I'd leave well enough alone.

I've had a bad lead for 7 or 8 years now and chose not to replace it when I had my last battery change. It's not out of position, it is ruptured and drains the battery quickly. My own personal opinion here, but I feel less invasive is best so I wanted to wait as long as possible to mess with it. It's doing the job and it's stable, that's good enough for me. My doctor let it up to me.

Cleveland Clinic

by ppt - 2010-01-05 09:01:16

The Cleveland Clinic offers medical opinion based on test results/reports etc but it is pricey....

Dislodgment

by pacemaker writer - 2010-01-06 05:01:43

I'm sorry you're having troubles! When a pacemaker and leads are first implanted, it is possible for a lead to become "dislodged" (that's the medical term). It may not be an error at all. Sometimes the lead just pulls away from the heart tissue. I'm not a doctor--I'm a writer who writes about pacemakers--but this kind of lead problem sometimes happens. (It is very rare for it to happen after the first few months--if a lead gets dislodged, it's almost always in the first weeks after implant.)

As for mixing leads and pacemakers (by manufacturers)--that is done all of the time. Leads are designed to certain industry standards so that everybody's leads work with everybody's pacemakers. In my opinion, doctors develop a preference for the leads they like best and the pacemakers they like best (just in terms of "feel" during implant and also functionality) and these sometimes cross company lines.

Medtronic had a big lead recall a while back for a defibrillator lead, but that's not what you would get with a pacemaker.

Lead dislodgment could happen with any lead. If they go back to surgically correct this, they may not replace the lead, just re-position it.

Hope this helps.

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