RV lead low impedence and insulation fracture

Hello! My husband is on his 2nd pacemaker. He is now showing a low impedence and insulation fracture. If it quits working he has another lead that will work his pacemaker but he will have symptoms from it such as palpitations and shortnes of breath. His local cardiologist suggests we get the lead extracted and get a new one now. The cardiologist at The Cleveland Clinic said we should wait until the pacemaker needs changed because it will increase his risk of infection if it is done now due to his long term need for generator changes since he is only 32. Does anyone have any experience in this field of leads? An oinion of getting it done now versus waiting? Thanks for your help.

5 Comments

leads

by Tracey_E - 2010-01-08 04:01:36

One thing about leads that you may not be clear on- if one doesn't work, the other one does not take its place. One works in the atria, the other works in the ventricle, they are not interchangeable. How does he pace (atrial or ventricle) and which one is impeded?

My experience... I got my first pm at 27, I'm 43 now. I pace 100% ventricle so I'm completely dependent on it. My ventricular lead has had an insulation fracture for 7 or 8 years now. It was left up to me when I had my last replacement if I wanted to keep it or replace it. It works and I have full function but it drains the battery quickly because they have to crank up the voltage to compensate for the leakage at the rupture.

I chose to keep it, I want to eek every year of life out of my hardware that I can because I've got a lot of years of pacing ahead of me and only so much space in my veins. Over the last year, it's gotten worse and it isn't as stable as it was, and my battery is about dead anyway, so I will be replacing it in the next few weeks. I don't know yet if we'll add the new one on top of what's there or extract and start fresh.

Extraction is fairly new. It used to be that they always opted to add a new lead and leave the old ones in, but as extraction sheaths have gotten better and more doctors are able to do it, more doctors are recommending removal over adding a new lead on top of the old.

If it works and he feels ok, I'd personally leave it alone until the battery needs to be replaced. That gives you plenty of time to think through your options and get other opinions. I'm still not sure what I'll be doing, but at my Nov visit I was told 3-4 mos left so I expect to make a decision next week when I get it checked again.

Lead Insulation Fracture

by donb - 2010-01-08 04:01:50

Hello! Your post sounds like a re-run of my experience a year ago. I was also on my 2nd Medtronic PM with original leads in year 1992. As my 2nd PM needed replacement in 2008 my cardiologist informed me of 1 of my leads had a fracture but paralleled the lead with the other when he did my 3rd Medtronic Enrthym PM. Within the next year rejection started where the leads attached to the PM generator resulting in erosion.

Now lead removal was high risk because of time since original implant. It was decided to do a complete right chest installation with a St. Jude PM and 2 new leads. Everything was successfull, no infection, but it took 2 plastic surgeries to repair my old site and of course now I'm also carrying 4 leads.

This all took place a year ago and also 9 months of treatment of Digestive disorder, namely C-Diff infection, the bad hospital bug resulting from over medication of antibiotics, namely Cipro. I had been plagued with that before in year 2000 with major back surgery, lasmenectomy. I thought you should have a little history as It's also my question, why lead removal?? There are new methods like lazer, but still some risk. Being your husband is young I can see adding leads is another item although lots of patients a 3rd lead. Lead removal was an option for me also but too much risk. If you have questions send me private message. donb


Another thought

by ElectricFrank - 2010-01-08 06:01:10

It should be possible to turn off the activity of the bad lead for a few minutes in the so your husband could experience the results of a failure. I had them turn off ventricular pacing to see how dependent I really am.

frank

Lead replacement

by ElectricFrank - 2010-01-08 06:01:18

He has had the old leads long enough that there is no advantage in removing them unless the bad one is causing problems. The only other issue might be the consequences of a complete failure of the lead at a time when medical help wasn't available or convenient.

I'm a bit surprised at the Cleveland doc being concerned about infection. While it is always a possibility, medicine doesn't seem to take this into account in things like colonoscopies or cadiac catheterization tests.

frank

low RV lead impedance

by sherida - 2010-01-22 06:01:34

If the lead impedance is very low in combination with unacceptable high pacing threshold (which results in high energyconsumption), implanting an new lead might be necessary. If pacingtheshold is high, but acceptable for the time untill pacemakerchange, this is preferred.
In case of minimal RV pacing (such as in case of SickSinusSyndrome with normal AV-conduction) , it can even be accepted if pacemakerchange is not yet an issue. When changing the pacemaker, something must be done with that lead, i.e. implant a new one.
Leadextraction is only carried out in cases where e.g. there is not enough room for an extra lead)
grtz
Sherida

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