Lead replacement

Hi,

I had my first battery change a month ago and at that time my cardiologist thought that maybe one of my leads wasn't fully working but he wasn't sure and that the surgeon needed to check it when I was in the OR. They did that and apparently there were no issues so only the battery was changed. I went to have my PM checked this week and was told that they noticed the PM didn't capture at one point so I am now scheduled to have a new lead put in next week.

I'm wondering how they don't know for sure that a lead isn't working or if there is anything else that could cause my pm to not capture every now and then. Listening to my cardiologist talking with the technician made it seem as though he wasn't sure. I had an xray done and the leads are still in place.

I'm only 27 and am assuming I'll have to have more lead replacements before all is said and done so I don't want to have extras in there now if it's not completely necessary.

4 Comments

odd

by Tracey_E - 2010-05-21 02:05:17

Patch is correct, a new lead could be diagnosed dislodged with an xray, but after you've had it a while it won't be much help. If you've had it long enough to kill a battery, coming loose where it's attached shouldn't be an issue. After the first year, scar tissue will hold it in place. It's possible for scar tissue to build up so that it's no longer capturing. A defect with the lead would show up on the reports so it almost has to be either scar tissue or the way it's attached to the generator.

If you are only 27 and truly need a new lead (as opposed to connecting it better to your new generator), the recent preference seems to be to do a lead removal and start fresh rather than add the new lead on top of what's there. That gives you more room down the road for next time you need a new lead, you're young enough that you will most definitely outlive your leads. If scar tissue is the problem, then you definitely want to at least consider a removal to clean out that scar tissue before adding a new lead.

Have you had a second opinion? I think I'd want someone else looking at it other than the dr who did the last replacement before I had another surgery.

PM Lead Concern

by SMITTY - 2010-05-21 03:05:51


Hello Sarah,

I'll add a little to what Patch and Tracey said and in so doing I may repeat some of the things they have already told you so I ask that you for give me for doing that. If I contradict something they said it will not be intentional and you should accept what they have said as correct.

During a PM checkup it is pretty easy to determine a failure to capture since that all that means to is the circuit between heart and PM is not being completed. One of the diagnostic procedures used to determine if failure to capture is happening is increasing the power output of the PM to see if the fault can be over ridden. That may give a hint as to where the problem lies.

If it is a poor connection between PM lead and heart wall then increasing the power output from the PM may overcome that fault. But that is not good as a pennant fix as it could lead to a shortened battery life. An X-ray of the heart if the problem is just a poor connection between lead and heart will be useless as the X-ray will not show a break or open space between the lead and the heart. All it can do is show a close proximity of the lead to the heart wall.

Increasing the PM power output may override a poor connection between the lead and the PM, but again that is not a reasonable solution because it shortens the battery life.

If there is a break in the lead, which is always a risk during a PM change out as those are very small wires that are being handled. Even if there is not a complete break in the lead a fracture of the insulation can occur which will make the lead defective.

I found your comment "Listening to my cardiologist talking with the technician made it seem as though he wasn't sure. I had an Xray done and the leads are still in place." interesting. Trying to determine why "failure to capture" is occurring is very difficult without having the pacemaker and lead in hand. So I can understand why the doctor wasn't sure.

I can certainly see why you would say "I'm only 27 and am assuming I'll have to have more lead replacements before all is said and done so I don't want to have extras in there now if it's not completely necessary." However, lead failure is relatively rare as many leads last for years. I will even venture a guess this will be a one in a lifetime event for you. Of course some of your leads may be replaced when you get new pacemakers in the future. I wouldn't be concerned about having too many leads in place. Whether a person has reached the limit on leads they can tolerate is just another decision they have to trust our doctor with and hope he makes the right decision.

Good luck,

Smitty


Capture failure

by ElectricFrank - 2010-05-22 12:05:59

This can happen with a normally attached lead. A couple of years ago I suddenly started having intermittent capture in my ventricular lead. We turned the pacing voltage up and restored it. After several weeks the capture threshold came back down to my usual. I had gone through some flu like symptoms and think it was some kind of virus that I had.

The other possibility in your case is that a detached lead can still lie near the heart wall. Blood is very conductive so the pacer pulses may continue to stimulate the heart most of the time. This wouldn't necessarily show up on an ECG, pacer check, or CT-scan.

Do you get a copy of your report at each checkup? It would be interesting to see the trend of your lead impedance, which might show something going on. A sudden change even though it is still in the normal range is an indication of problems. Most cardiologists have no idea what it really means. It just a reading to them. Of course they are electronic types.

frank

Feel your heart beating harder?

by Nevada Silver - 2010-06-14 05:06:22

I'm having my first battery change on my ICD tomorrow, 6/15...a little nervous...What I have been noticing especially when I lay down at night, my heart seems to beat harder and a bit faster...bp ok...but it concerns me. I went to the ER last week and they could not detect any arrhythmias on the Ekg or on the cardiac monitor...I even told them when my heart went back into it and they didn't see anything...Saw my Cardiologist 1 week later...they did a 12-lead Ekg...he also said he saw nothing unusual. The tech tested my ICD and immediately said "we'll just turn it off " as the battery is nearly out...I was nervous, not knowing what to expect next and tomorrow...get a new battery. They gave me a rx for Zanax and last nite I had another incident with the heart...that causes me to just get up out of bed and go do something to take my mind off of it..If this is caused by stress...any answers about why the medication isn't stopping it ? Thanks everyone!
Take good care...Ask questions and get answers from your physicians...
Nevada Silver

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