lead replacements

Hate to bothr any of you guys but I just have to ask this.
I've had a lead issue since 12/11. Dr. has suppose to have been monitoring but have not! Anyway, I have an appoiintment next week for 6 month interigation. I want to know what to ask this dr. Have had PM nearly 20 years now with NO problems at all other than normal generator replacement. Should probably wait to see dr. before I go any further but:
As long as leads have been in will both be replaced
How long does the procedure take (lazer surgery has already been mentioned)
What are the chances of open heart to do/finish procedure
Generator is due to be changed at any time. Should this be done at the same time.
Has anyone out there on the site had leads replaced.
The closer I get to next week, the more anxious I get. Not really happy with the dr. office. Left 6 messages over 5 weeks and none replied (don't know if it is dr. or office staff.
Any words of "WISDOM" ould be appreciated! I'm 69 years YOUNG and have aged 10 years this week!
Thanks,
Cecil (manaman)

3 Comments

How to vet an EP for Lead Extraction

by donr - 2012-06-13 01:06:10

Cecil: As promised. Found it!

Don

Lead Extraction Interview
Comment posted by donr on 2012-03-08 00:06.
PM5: As promised, here is a long discourse on how to vet a potential EP for a lead extraction. It is a compendium of several open comments I've made in the last couple months, so it may seem a bit disjointed. I've edited it to take out other's names & tried to tailor it to your situation. Don
Begin Paste:
Comment posted by donr on 2012-02-18 09:45.
XXXX: There are actually three options: 1) Just add a third lead in the current vein. 2) Move the PM to the other side, abandon the original leads & install leads on right vein. 3) Extract bad lead & add new in current vein.

First of all, I'm ASSUMING you have 2 leads currently - you didn't specify. That's my situation.

I lost a lead after about 4 yrs - complete fracture w/ about a 4 inch gap between the ends. My EP & I discussed it before a surgery to add a third lead. IF he found inadequate space in current vein, he wanted my approval to move PM to right side & use that vein system. I agreed.

My EP was NOT too keen on the idea of extraction (2007). We also discussed this as an option before the surgery. He said HE DID NOT do them because it was a complicated procedure using a laser "Roto-Rooter," & he did not do them because he was not comfortable w/ the procedure. Several months ago, I sent Pookie a series of questions to ask any surgeon prior to allowing him/her to do an extraction. I'll copy them below for you.

Your profile lists you as living near XXXXXX - that is not exactly a backwater of medical competence - there may well be an appropriate EP there who could do the job. If not, you are w/i driving range of Atlanta & Emory University Medical center. They have a potential candidate for the job here. He is my EP! If you decide to explore this option, Private Message me & I'll give you his name. We have 5 major hosp's here that do complex heart procedures; surely there is one that has a surgeon acceptable to you.

This is a COPY & PASTE of MY open comment to Pookie on this subject. Her Originating Post was on 10 Jan 2012 & titled: "Lead Replacement Question."

BEGINNING OF QUOTE (BTW: Some very minor editing to have it make more sense to you.)

WHAT IS AN EXPERIENCED EP?
Comment posted by donr on 2012-01-10 17:38.
Patch is right - you don't want some surgeon fellow doing this. (FELLOW - a surgeon in training in the specialty)

Find someone who does it all the time - at least 100 SUCCESSFUL removals per year. Oh, yes, macabre as it sounds, ask about his/her mortality rate. Any surgeon worth his/her salt will openly discuss this with you. (BTW: this is pretty much the same criteria used for finding a surgeon to do a radical prostatectomy, another extremely complicated & delicate procedure.)

Remember that your life is going to be in this person's hands & you will be totally unconscious, having absolutely zero control over your fate. You want to interview them just as you would if you were hiring them to work for you - WELL, you are, aren't you. Some questions to ask:

1) how long have you been doing this procedure?
2) how many total have you done?
3) how many do you do per yr?
4) Do you LIKE doing this procedure?
5) Do you do it in a professional environment where there are other surgeons doing it, but you are more comfortable doing it than they are?
6) Are you the predominant surgeon performing this procedure here? (Wherever "Here" is)
6) Tell me what your success rate is.
7) Lets be morbid - what's your mortality rate?
8) What is/are the most common complications of this surgery? Characterize them as minor or serious (life threatening)
9) Supposing you get halfway down the vein, successfully removing the lead - is there a way to terminate the procedure at this point if something goes south - other than the procedure, itself? What about if the problem is in the procedure you are performing?

Do NOT be shy about this. You have to be truly "Pushy" & take no waffling. I think I'm preaching to the choir here.

These are the kinds of questions my Cardio's head nurse says to ask.. Their practice is associated w/an EP who does this at a major university med school hosp. He is the predominant surgeon performing it; he thoroughly enjoys it; other EP's prefer to let him do them; he does well over 100 every year. Etc. etc., etc.

AN INTERVIEW TALE:

I interviewed in 1973 an orthopod who had to do a rather rare procedure on our #1Son - stop his left leg from growing longer. The first question I asked him was "Have you ever done this before?" You'd-a-thunk I kicked him in the belly - but he answered "No." My next question was "Well, how do you know you can successfully do the job?" Another kick in the belly. Half hour later, after he'd finished convincing me that he could do it, I shook his hand & told him "You've got the job." Seems that it is a very straightforward procedure, but so rare that it is only done in children's orthopaedic hospitals. Most orthopods never even SEE it performed - they just read about it in books. At this point, he dragged out a moldy old text book & we wallowed around in it talking about the job to be done. And - it was a smashing success.

You need to find someone like our orthopod - who is willing to be vetted & willing to talk about the job openly, comfortably & openly - warts & all.

END OF QUOTE

How do you check EP's out? The Web has info on a lot of surgeons w/ patient ratings. It also has a lot of info on what their specialties are, so get any name from a med center or just a Google search for a given city & you should be able to winnow the list of candidates quickly for an interview/consultation.

Go get 'em!

And the very best of successes to you

Don

A bunch of info on lead extraction

by donr - 2012-06-13 01:06:45

Cecil: here's a couple comments about lead extraction from a post just this past mid May. So, it's current. Most important, you want to read this article on the web:

http://www.hrsonline.org/news/media/press-releases/upload/leadextraction_cieds.pdf

If you read this, I think you'll decide to find another EP to do the job.

Buried somewhere in the bowels of this sit is a comment I once made baou5t how to vet your potential EP's to do this job. I'll see if I can find them again & send them to you.

Don

Begin old comments:

Comment posted by donr on 2012-03-22 23:22.
Lizzie: It's done all the time! No, it is NOT a trivial procedure, so they don't do it just because you want an MRI safe PM. Below I've inserted a comment I made to someone else about lead extraction. It has a link to a very good paper explaining the pluses & minuses & risks involved. I faced a potential lead extraction several yrs ago & had a long discussion w/my EP about it.

Leads extraction is not performed at every hosp, either. It takes a very special person to become adept at it & every EP does not want to do it.

Your cardio quoting 5% mortality rate is pessimistic. It is more like 1% for a competent, well experienced EP - which is a far cry from 5%.

Wish you the best in your quest for info on this.

Begin Cut & Paste:

Want to read a scholarly work on this?
Comment posted by donr on 2012-03-10 09:50.
Last night, after reading at least three posts on lead extraction questions, I went to Google & found this PDF format document by the Heart Rhythm Society. All sorts of interesting info in it. Like what are the conditions for removing old leads. Criteria for a surgeon to be adequately trained & experienced in lead extraction. Mortality rates for the procedure (under 1% for an "Experienced" surgeon). It's a 45 page document, well written & truly interesting - IF you are a PM Host facing a potential lead extraction. recommendations on what type institution you should go to for the procedure.

http://www.hrsonline.org/news/media/press-releases/upload/leadextraction_cieds.pdf

End Cut & Paste

Mortality rates
Comment posted by ElectricFrank on 2012-05-16 01:48.
I'm not advocating any particular decision or approach, but though you might like to consider this:

1% mortality sounds pretty low and unlikely. This means that of every 100 procedures 1 person will die. To put that in perspective would you consider an airline trip if 1 of every 100 flights had a fatal accident? Or what if 1 of every 100 takeout pizza's had a fatal poison?

It helps to put these statistics in understandable form.

Great Percent Factor
Comment posted by donb on 2012-05-17 11:14.
I just love your example of 1% mortality rate. My 5% figure for my Lexiscan test put me in the ball-park of having a severe reaction. Happily I've survived for 3 months, have to go back for more blood work to see how this body is repairing the damage.

donb

Statistics
Comment posted by ElectricFrank on 2012-05-18 00:54.
I forgot to add that a 1 in 100 chance of death means nothing when applied to an individual. If I try to imagine what that means to me it goes nowhere.

Now if I was an insurance company dealing with thousands of customers the risk factor is a matter of Population Statistics, and is a reliable way of predicting payouts.

Strange,

frank

Ah, Statistics & Lies & Damned lies
Comment posted by donr on 2012-05-19 20:29.
Frank - my favorite issue w/ statistics! They cannot be reliably applied to an individual. After all, statistics are made up from data from a bunch of individuals! Some of them are 3 sigma to the right; some others are 3 sigma to the left. Some of them are actually right on the mean or median.

When you look at statistics as a measure of the capability of a surgeon, you have no idea what the population is that he/she operates on. You have no idea whatsoever where you as a patient stand in the universe of his patients. If you are going to some Dr. who just does easy, straightforward, low risk cases, it is significantly different than if he/she does a lot of very high risk, complex cases.

Another issue for folks in here - they are not generally looking at a procedure that is truly elective. Most of the time, the "Do Nothing" option is not a low risk option We have to choose among a bunch of options that have varying degrees of risk, so we are looking for essentially the least worst option of the many we face.

F'rinstance, on a lead extraction - a 1% mortality rate is a heck of a lot better than a 5% risk - GIVEN that the "Do Nothing " option could lead to some rather more serious consequences. Therefore, we must weigh the "Do Something" risk against the "Do Nothing" risk, as opposed to looking at it standing alone.

Don

Just had leads replaced

by Mary1998 - 2012-06-14 12:06:41

They can install new leads and leave the old ones in. Sometimes they can go down the same route the original leads are in and sometimes they move the pacer to the right side and install new leads from there into the heart. The exact route I'm not sure of.

I just had new leads placed last week. They had to move my pacer to the right as there wasn't enough room to add new leads to the existing route.

Please get pro-active with your doc. I had my original EP do the surgery. As soon as I'm back on my feet, I've got an EP picked to talk to as a consultant/2nd opinion. I would have talked to him first, but time didn't allow me to.

My EP didn't want to remove the leads because of the danger. I agreed. From the articles I have read, you want someone who does 100+ a year in a place that is known for the surgery, as it's not one to take lightly.

Best of luck to you!

You know you're wired when...

You play MP3 files on your pacer.

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