epicardial leads

Does anyone have epicardial leads? If so -- are you pacemaker dependent? And how long have you had them and are they expected to last long. Was the surgery extremely painful? I am considering declining on a risky wire extraction surgery and asking for epicardial leads instead. Thanks in advance for any information.

6 Comments

risk

by Tracey_E - 2010-04-14 10:04:23

How many leads do you have now? Is it too many to start new on the other side? Epicardial is generally considered a last resort after adding on top of what's there, moving to the other side, and extracting.

Are you concerned about an extraction in general, or is there something that makes you an especially high risk? Extraction has come a long way in the last few years, both technology and the number of experienced doctors performing it.

leads

by mjbdelay - 2010-04-14 11:04:55

Thank you Tracey. I have 5 leads on the left. I am pacer dependent with 3 leads inplanted in 1990, 1 in 1994 and the last in 1998. After a work related injury that fractured my atrial lead leaving only the ventricular lead in functioning. The docs are not in favor of moving to the right because both sides enter the heart thru the superior vena cava and they think that adding leads may be too many.Saying that I am extremely concerned to have the surgery is an understatement. I am told that the extraction may have increrased risks due to the age and type of leads. Now I have to make some sort of move-- the battery life is <1-8 months as of yesterday. I find it difficult to research my options. That is why I turned to this site. Any info is appreciated. Thanks for your response.

I have epicardial leads

by golden_snitch - 2010-04-15 01:04:21

Hey there,

I have two epicardial leads (left ventricle & atrium) since October 2008, only had one atrial, transvenous lead before. But then I needed an upgrade, and since I have had superior vena cava reconstruction, and still have occlusion of the left subclavian vein and stenosis of the left innominate vein, there was no way to get in another transvenous lead.

Surgery was done under general anaesthesia, it's not possible with a local. For the epicardial leads they went in between the ribs below my left breast, the incision is about two inches. They also had to open up the pacer pocket incision to, not only because I needed a new pacer but also to be able to attach the new leads to the pacer unit. The leads were sewed to my left ventricle and left atrium, and the "tunneled" under the breast tissue up to the pacer unit.

I'm sorry to have to say that the pain after this kind of surgery is not at all comparable to a normal pacer surgery which is mostly because of the incision between the ribs, and also because you actually have two incisions and not just one. The first three weeks were pretty rough but I also had some minor complications: pleura effusion, subcutaeneous emphysema, and then after three weeks also had a pleurisy. So, it took me much longer to recover than from normal pacer surgery.

Epicardial leads usually do not last as long as transvenous because of the surrounding tissue. In a vein there is not much pressing on them but when they are tunneled under, in my case, breast tissue that moves whenever I move, it's different; there is more "rubbing". Epicardial leads in the past also often needed a higher output to stimulate the heart (higher threshold) which then drains more battery. But there has been lots of improvement until today.

After all, I would prefer transvenous leads because ever since I have the epicardial leads I have the feeling that I can feel the "rubbing" of the leads under my breast. It's a bit uncomfortable, not painful, but just not what I had expected. However, maybe mine are just not placed very well, maybe other surgeons can do better.

Hope this helps a bit.
Best wishes
Inga

epicardial leads

by mjbdelay - 2010-04-15 02:04:07

Thank you for all of your responses. I am greatful for all information and it is helpful.

thoughts

by Tracey_E - 2010-04-15 07:04:24

Cleveland Clinic is considered the cutting edge on all things heart and pacemaker. Dr. Byrd in Ft. Lauderdale pretty much invented extractions but he retired last summer. He had partners but he had a reputation for working alone so I don't know if his practice is still considered top notch. I don't know who else does them but I've been told it's a lot easier to find someone than it used to be. Ask how many they do a year, if it's under 100 keep shopping. Have you done a search of past posts? Finding an expert has been discussed before and specific names mentioned.

Question... do you pace atrial? Another member and I have had this discussion. She has a lead that fell years ago and it just sitting in her heart so she's not an extraction candidate. She's been paced longer than you and has as many leads, and an atrial lead that needs replaced. We both have congenital av block and are pacer dependent- but ventricle. Theoretically that means we could do without the atrial lead. If you pace ventricle, maybe ask about turning off the atrial lead and see how you feel without it. It's not a forever solution, but it could buy you some time to think about it and do your research. If you pace atrial, then nebbermind ;o) Most of us long-timers seem to be CCHB and pace ventricle.

If your leads are placed normally, even with five of them, extraction is a serious surgery but not considered high risk anymore as long as you find someone experienced. The laser sheaths they use have come a long way even in the last year or two, and more doctors have been able to become proficient at it.

I can think of more than a dozen members who have had it done with only one serious complication, and I believe her situation was similar to the member I just mentioned with a complication going into it that made her risk level higher than average. The rest all came out of it just fine. I know, it's still scary!!! I looked into it because I just had a lead replaced in Jan and extraction was discussed. We were able to fit it in so I was able to procrastinate a while longer. I hope you're able to find a solution you're comfortable with. The first thing I would ask is if you switch to epicardial, what happens next time one goes bad? You're young enough that that's a reality.

Good luck!!!!!

Medical school nearby?

by valbob89 - 2010-04-15 12:04:09

MJB: If you have a university school of medicine nearby, or a teaching hospital, try asking there for a referral. Either place probably won't be free, but those are the places with the top experts in your state. I'm in San Francisco, and have the great fortune of being able to turn to UCSF. There's also Stanford a half hour away.

Maybe you can call your local med school and ask for an advice nurse. While that department may not have an electo-cardial expert, he/she can surely find more resources for you.

Have you already asked your cardiologist for a referral or second-opinion suggestion? Mine sent me to an electro-something-cardio-guy (electrophysiologist?) at UCSF for a reading before we resorted to installing my pacemaker about 5 years ago.

There's also a chance that the tech rep for your pacemaker manufacturer, the person who works with your cardiologist for semiannual testing and such, can help. Do you usually see her for your routine exams? You can ask for details while your doctor is outside....

Being no expert at all, I can only guess and hope that the techie has dealt with questionable leads before, and may be able to advise the doc on testing to be sure that no alternative exists before ordering the surgery..

That's my much-more-than 2 cents worth.

Best wishes, and let us know.

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