Repositioned PM

Hi

I had my pm implanted Jan 2010. Everyting seemed fine but in July I had to have it repositioned as it had moved out of its pocket. It seems to be doing the same thing again and I now have terrible pain in my shoulder and arm. The pm does protrudes if I raise my arm. Is this normal? I'm due a further check mid Jan. Should I be worried/concerned?

I'm a new member and have used this site for info over the last month or two and its the best I've seen so I have confidence I'll get the best answer(s). Thanks

6 Comments

PM location

by agelbert - 2011-01-04 07:01:57

Hi Milrose. I'm sorry you are having pain and experiencing PM protrusion. My PM is just over 4 years old now with two leads. I have read about what the EP doctor does when the implantation takes place. Normally the point at which the lead(s) enter the subclavian vein (routine location for left sholder PM implant) to go to your heart has a suture sleeve that encompasses the lead(s). They attach (ligate) the suture sleeve to the vein. they fix the suture sleeve to the fascia so that, while there is some longitudonal lead movement allowed, there is a limit so the lead positioning in your heart is never disturbed. They make a little loop in the direction of the PM to allow for lead slack during your body's movements (from the vein exit to the PM). All this is designed to be robust and ensure your safety. Now if the PM is, for some reason, being pushed out of its' pocket, the loop in the lead(s) should avoid problems for you until they fix it. Even if your PM puts tension on the lead(s), they are normally designed to NOT affect the entry point into the vein because of the ligating and suturing in that area. In other words, your PM is still working even if it is out of position. The tugging on the lead sutures probably doesn't feel good at all. If I were you, I would request a repositioning as soon as possible because of the pain. I would also ask the doctor if I could reduce the pain by adopting some body position or limiting my left arm movement with a sling to avoid further PM migration.
I'm not a doctor. I'm just a patient trying to help a fellow PM patient. I hope you are tended to soon.
God Bless you.

comfort

by Tracey_E - 2011-01-04 08:01:15

It can be normal for it to protrude somewhat, esp if you're thin, but excessive pain is not normal. I'm no dr, but I suspect you're dealing with an inconvenience, not a danger. Pocket problems are generally unrelated to how the pm functions.

I would suggest bringing it up with your EP first, but then seek a second opinion from a plastic surgeon. Mine was placed by a plastic surgeon the first time and the last time I had it replaced (4th one) a plastic surgeon assisted again to clean up the pocket because the scar tissue was building up and starting to get uncomfortable. EP's are heart specialists who do surgery, a plastic surgeon specializes in making things look and feel good, it's what they do. The ep has already had two shots at it, I'd get a more specialized surgeon involved before allowing another surgery or living with the pain.

Thanks

by Milrose - 2011-01-05 07:01:12

Wow, I feel so much better now. As they say it is good to talk!

My surgeon did mention using a plastic surgeon when it was repositioned but hey I thought its only a tiny scar. Never imagined scar tissue inside could be a problem. Not able to use my arm a great deal but have my check in couple of weeks and see my Cardiologist week later. I'll keep you posted. Was worried because he said if happens again would have to cut through my muscle to bury it deeper and that that has additional complications. Didn't like the sound of that!

Apart from this I'm doing great and thanks for taking the time to share x .


muscle

by Tracey_E - 2011-01-05 11:01:29

A lot of drs don't like to put the pm under the muscle but quite a few of us have it that way and like it. Healing is a little longer and you'll probably be pretty sore for the first few days to a week, but once it heals it's great!

Complications depend on how they do it. They can put it between the pectoral muscles, that's usually considered the least troublesome place because it's going between, not in muscle. Mine is behind the breast, much more involved surgery to get it there but you can't even feel the lump. This is where the plastic surgeon is handy. The cardiologist probably has not done many (if any!) other than the usual placement under the collarbone just under the skin. A good plastic surgeon has done reconstructions and implants and knows all about how to make it feel good, this is a piece of cake for them.

Decision made

by Milrose - 2011-01-05 12:01:52

Thanks TracyE. If I have to have pm repositioned again going to ask about having it between the pectoral muscles. Doesn't sound so daunting. Plus just read posting by Horseride and I have the same 'lumpy bump' between my 2 scars. Doc says this is the leads (and he thinks they're too raised and need sorting) so I guess the whole cabuddle may need to be deeper.
Wish me luck!! x

good luck!

by Tracey_E - 2011-01-06 07:01:58

Please check in and let us know how you're doing.

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