Leads wearing out

Hi all,
I've just found out that both my leads need replacing (was suffering strange heart twisting sensations) . I'm a little worried to have the surgery again...will it be under a general?
Grateful for any info

6 Comments

Lead Removal

by Juan - 2011-01-01 09:01:07

This part of what D Cleveland Heart Clinic has to say about getting pacemaker leads removed.
"You will likely be given general anesthesia, which will cause you to “sleep” through the procedure. If you are not given general anesthesia, you will receive medication through your IV that will make you drowsy throughout the procedure. An anesthesiologist will be present during the entire procedure. If you are uncomfortable when you wake up, please tell the anesthesiologist. You may feel a pulling as the leads are removed, but you should not feel pain. Your doctor and nurse will be with you throughout the procedure. If you are uncomfortable or need anything during the procedure, let your nurse know."

Depends...

by golden_snitch - 2011-01-02 05:01:35

Hi,
that depends on if the old leads will be removed or not. It is very common to leave the old leads in, unless for example your veins are not wide enough to fit in one or two more leads. Removing leads is generally considered to be risky, and should only be performed by experienced surgeons. If the leads will be removed, I would guess that you get a general or at least a conscious sedation. If not, it'll be a procedure very much like your first pacer implant, and that can be done with a local anesthesia.
Best wishes
Inga

Lead revision

by jvaltos - 2011-01-02 11:01:27

Ruby-

It would be quite unusual for someone to need two new leads. I have never seen it happen that both leads need to be replaced from "wearing out." Especially at you age and given how recently they were initially implanted.

SOOOO, I would love to know what the thresholds and lead impedences are as this raises some suspicions.

I am sure that it is possible, but I would be surprised.

Now, if you do in fact need two leads, at your young age, I would opt to have the "bad" leads removed. The risks used to be much higher that they are now, but with the advent of laser lead extraction and in the hands of experienced people the risks are much lower. The real reason is that 4 leads in such a young person who is going to need more battery changes, etc in the future could mean a much more difficult time trying to remove 4 leads later on.

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.

Dr Valtos

by ElectricFrank - 2011-01-03 01:01:35

Here's a question. Does the inside of the heart have enough enervation to feel what leads are doing. I see this on the site once in a while and have wondered.

I had my original implant done with only a local (no sedatives) and was wide awake. I have the Medronic screw in leads and I never felt a thing as they were inserted. I was aware when it was done from the conversations in the OR as each was inserted, impedance, and pacing voltage tested before connecting them to the pacer.

thanks

frank

Dr Valtos

by RubySlippers - 2011-01-03 06:01:26

At the moment I'm not sure if it will be both leads but know it's definitely the atrial one that appears to be malfunctioning. I'm starting to have many near Syncope episodes again ( very much like my pre-pacemaker ones) . My pace setting is to come in at <60 and I've had the leads for 10yrs now. I have found out today that they will be extracting the leads. I wonder if you can suggest any questions that I might need to ask, I've never received much support since I was implanted. My condition is malignant vaso vagal cardioinhibitory response syndrome. It's my cartiod sinus that caused my problems.

Many thanks for your response

@ Frank

by jvaltos - 2011-01-03 11:01:28

Frank-

Typically, people do not feel much with leads in the heart. This seems to be especially true with respect to the right side of the heart (where the predominance of leads lie.)

When performing a left heart cath (angiography), patients will often tell me that the feel the cathethers, but I suspect this is more to do with the sensation around the aorta and with the PVCs.

The inside of the heart is not a nerve rich area so this would be improbable, but as you and I know, I believe patients are all different and wouldn't be surprised it someone could occasionally feel the leads at work. (Not really hedging, just some wiggle room!)

Dr Valtos


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