Lead Sleeves

Hi everybody; I've not posted for a while and was hoping if someone could please help.

Nine months after my implant, I am still having pain and discomfort at the PM site. Having gone for a second opinion, the Consultant has diagnosed that the Lead Sleeves are extremely superficial, and this is what is causing the constant prickly soreness. The discomfort is coming from a nasty "lumpy bump" just above the PM scar, and I am worried, that as an active person - (golf, swimming and horseriding) that the lead sleeves may eventually poke through the skin?

The Consultant has offered to re-do the procedure, but has offered no guarantee that my symptoms would improve. Additionally, I would be terrified to go through the operation all over again, so I don't know what to do.

I would be most grateful to hear if anyone else had a similiar problem or could offer some advice. Thank you.

4 Comments

Decisions, Decisions

by SMITTY - 2011-01-02 07:01:16

Hi Horseride,

I know it is a bad situation to be in but I would have to say you have one of two choices. (a) Let the consultant go ahead and put the leads deeper, provided he will say for certain he can do a better job than the first Dr. (b) Continue to endure the pain and discomfort and worry about the leads poking through the skin.

If you elect the second one and the lead were to poke through my guess is it would not damage the lead and then you could get the necessary repairs. Another thing if it did damage the lead you would be without benefit of your pacemaker for a few days. However, all that would probably mean is your situation would be no worse than before you got the PM. Your heart function would simply revert to what it was doing before you got the PM.

Eventually you will most likely have to get the repair surgery. I think doing those repairs now would be better than waiting. If it is going to have to be done some day and the less time the leads have been in place the easier it will likely be to move them as necessary to do the repair job so the quicker the work is done the easier the surgery. On top of every thing else, the sooner you have it done the less worry, pain and discomfort you will have.

I have had two pacemaker surgeries. The battery ran down on my first one and I had it replaced. The pain or discomfort for the second one was about the same as the first, but since I had been through it one time already, there was no stress the second time as I knew what you expect.

With all that said, I realize you have a tough decision and I wish you the best with your choice.

Smitty

Suture sleeves

by jvaltos - 2011-01-02 11:01:47

Horseride-

As an implanting physician, I would recommend that you get the surgery.

A few things to help ease your fears. The repeat surgery is fairly straightforward as the consultant should only need to re-open the pocket and sew the suture sleeves down tighter after moving them a little.

I would also recommend a few things. Ask the other physician to cut off the "wings" on the suture sleeves if the leads have them. They are not needed and some manufacturers do not have them (Medtronic leads do.) Also, please ask for antibiotic coverage for at least 5 days as the infection rate is higher for the subsequent procedure versus the initial implant.

You probably shouldn't wait because if there is skin erosion and then infection, the results could be disastrous.

Good Luck

Dr Valtos

Always consult with your personal physician about medical advice and only make changes in therapy based on his/her personal recommendations.

Feeling the leads

by ElectricFrank - 2011-01-03 01:01:43

I'm very thin skinned in the pacemaker area of my chest and can feel the leads and connectors on the device. So far I haven't had any problems with mine though after both the original implant and a replacement. I do a lot of off road driving in my Jeep with the shoulder strap over the site so it gets a lot of bumping and rubbing. By nine months yours should have settled down so I agree with Dr Valtos that it would be best to get the problem corrected. Keep in mind that if the lead positioning is corrected it shouldn't take as long to heal. I was back to pretty much unrestricted Jeeping in 3 weeks.

The antibiotic recommendation is a good one also. Both times my cardiologist used an IV antibiotic before and after the surgery and I never had even a hint of infection.

As for being terrified of the surgery, I would be much more terrified sitting atop one of those horse.LOL

frank

Lead Erosion

by donb - 2011-01-03 11:01:19

I just want to add a suggestion so that your lead repair is sucessfull. My Cardiologist was not familiar with recontruction after removing my PM because of erosion. He referred me to a good plastic surgeon instructing him how he wanted it done. As a result my leads eroded within 30 days. Knowing this surgeon from other family surgeries I had a serious sit down appointment with him before he did a complete reconstruction surgery. As I had a complete right chest implant with another pair of leads he removed the bulky lead terminals which eroded twice from my old site. He also took care of lots of scar tissue, 17 years and 3 PMs' worth. He also removed the excess coiled leads, put in a small implant pading. He had to do a lift to replace skin. Really what I want to suggest is talking with you Dr. about the procedure or getting an opinion from a good skin Dr. because as mentioned, Infection is a bad word. I had 4 surgeries in just a few months with antibiotics, no infection, BUT, again the unbalance of good bacteria in my digestive system with the bad hospital bug bacteria which is a #1 problem in hospitals today. I might mention the cover all antibiotic used for me was Cipro. I'm sure you'll do OK with having your site & leads secured. Also, I'm a skinny person, could use a little fat under my skin!! And, as it's been mentioned many times on this site, ask questions from your surgeon with answers to your satisfaction, You are not a number, but a human person!!donb

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