lead extraction

i have had a pacemaker since 1985. i was 23. in 2000 after a battery replacement i had some severe pains immediately after the replacement. turned out i had some faulty leads and went in for replacements. they kept the faulty ones in and added two working ones switching my pacemaker to my right side. in 2007 i went in for another battery replacement. again they found a faulty lead. they inserted a new one. still leaving the old ones in. now i have 5. well it has just been discovered only one lead is working. they have scheduled me for an extraction. hoping to remove 2 but possibly all 5. im scared to death. i dont want them removed. do i have other options? whats the risk compared to refusing the surgery? heart block since birth. i read something about how it can appear the leads are malfunctioning when in fact they arent. i havent had an x-ray. they are going on an echogram. the cardiologist doing the extraction is not my doctor, he was referred by my doctor, he supposedly is top 3 in the nation. he says the risk is 1 in a 1000. is that good? bad? hes in the top 3. but of how many? 4? 100? i have tried calling to see him so i can ask him these questions but hes apparently a very busy man. my cardiologist says im very lucky to get dr. stark i need some sleep i have been sick over this for 4 weeks. any consolation out there? thank you.

6 Comments

One last Slap!

by donr - 2011-02-28 01:02:24

Just read, after posting my preceding comment, a quote from President Franklin Roosevelt. Now I realize he is just a name in history books to you, but to me, as an Old Fahrt, he is first Person knowledge. You see, I was a lad during WW-II & remember him quite well. Whether one agrees w/ his politics or not, he was a real leader of our nation during a time of great peril (Get where I'm going?).

In his first inaugural address at the depth of the Great Depression, he said:

"Let me assert my firm belief that the only thing we have to fear is fear itself - nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance."

Think these words of wisdom just might apply to you?

Now, to shift gears & quote Dr. Laura: "..Go out and have a good day!"

Don

leads

by Laben - 2011-02-28 08:02:45

I had two leads removed and replaced after 7 years and 5 years later a third lead was added, all without any problems. Wish you well. Laben

which lead

by Tracey_E - 2011-02-28 09:02:04

Which lead is still working? If it's the atrial you might be able to get away with procrastinating but if it's the ventricular, that's the one we are dependent on with av block. The risk of not fixing it is you stop pacing and end up with your natural very low heart rate. If it's atrial, the risk depends on how much you pace atrial. I have av block also and pace 100% of the time, I would not take any chances with my ventricular lead but I'd consider letting a bad atrial lead alone because I rarely need it.

They'd usually know a lead is bad by checking the pm on the computer. If it's not pacing, if the computer isn't reading it, or if the impedance has jumped, that means it's bad and I really don't think that could be a false diagnosis.

Extractions have gotten much easier in the last few years. The lasers they use have been improved greatly, the number of experienced drs has gone way up, the leaders in the field have become more expert. It's not considered high risk anymore when done by an experienced dr, and the definition of experienced is more than 100 per year. They use a sheath that surrounds the lead, then go millimeter by millimeter cutting the lead away from the scar tissue. Painstaking and tedious but not dangerous. Top 3 in the country is EXCELLENT, you're in good hands.

The risk is that they perforate the heart when cutting the lead away, they sometimes have to do open heart surgery to fix it. 1 in 1000 means that happens once for every 1000 times they do it. Very low odds. We have one member here I know of who had that happen but that was several years ago. Her recovery was longer but she's fine now. Everyone else who posted about it sailed through it. If you go through the old posts (search for "extraction") you will find their stories.

Good luck!!! I had a bad lead last year and was considering extraction, so I did a lot of research and asked a lot of questions. Turned out I was able to fit one more in (I have fewer than you, most can't hold more than 3-4 so 5 is really amazing) so I was able to avoid it for now. All of us who start pacing young will eventually face an extraction.

Extraction - but not teeth

by donr - 2011-02-28 10:02:32

Fojimo: Take this as grabbing you by he shirt front & giving you a good, hard slap across the face!

Get a grip on yourself & force some rationality into this situation.

1) you have been dealt a bad hand of cards in this game of life.

2) You face a Hobson's choice - that is no choice at all - you must have something done. Every day you put it off you get older & the risks go up.

3) Putting more than three leads into that vein is kinda screwy, at best. I have three leads in my vein, courtesy of a lead that broke somewhere in the middle of the vein.

4) My EP said he would NOT put another lead in that vein. He'd go to the other side & re-do the entire PM placement. He said the risks were too great to remove a scar encapsulated lead. (Wait before you go into stress!) Got a new EP (for other reasons) who removes them all the time. Says the procedure is now safer (read what Tracey says about it) - he has become the "Go to Guy" at Emory University here in Atlanta because he has confidence in his ability & has done so many of them because Others don't WANT to do the job. BUT... he will take time to talk to me about the potential for the job. I don't care how good a surgeon is, if he/she won't treat your head over the procedure, find someone w/ less of an ego who will! One of Napolean's Marshalls once said "...the mental is to the physical as three is to one..." That is so true in cases like yours.

5) 1 in a 1000 for failure are pretty good odds. Heck of a lot better than 66% failure rate!!! There are procedures w/ that kind of failure rate.

6) No X-ray? Why not? That's how they found my broken lead - but it took THREE X-rays over several months before it truly showed up broken. And then it was a radiologist looking at my lungs for pneumonia who saw it for the first time. W/ the bowl of spaghetti you have in that vein, if they can differentiate anything, it'll be a miracle!

7) SLAP! SLAP! SLAP! All for good measure. Yes, you are authorized to be very concerned. This is a difficult, even dangerous procedure you face. Do you have an option? Yes! Refuse the surgery. You do NOT have to have it. It's YOUR decision. This is called the "No Action " decision. What are the consequences of this decision? I don't know. You need to talk to an expert. But face it, one of the consequences of ANY decision is death. ANY decision. You are a big boy - you can handle the truth. Only YOU can handle it. Just don't try it alone. You just have to evaluate the probability of that outcome of every possible decision. This Dr. Stark (or one of his lieutenants) owes you this long discussion. Go get it!

8) You are authorized to be scared. This is not an easy decision. You just need a bunch of research - even including the dreaded "Second Opinion." You said that Stark is "...supposed to be among the top 3 surgeons that does this..." CHECK him out. It's your life on the line while unconscious on the table w/ him holding the laser.

Good luck, lad.

Need more advice just ask.

Don

Thank you

by fojimo - 2011-03-01 05:03:47

Wow. I just got e-slapped by don. Thank you for that as it really did wake me up. Thank you all for your responses and encouragement.
Tracey it is the ventricular lead that is fractured. It has been fractured since April but not discovered until January. It never showed up during my routine battery checks.
My surgery is scheduled for the 8th of March. I honestly dont know how i didnt think to get a second opinion, The thought never occured to me. I dont know if I should postpone surgery to get that second opinion. Is it really necessary? My cardiologist, The pacemaker rep and Dr. Stark all have come to the same conclusion. Im not real sure what else i should be doing or what I need to know. I have tried researching Dr. Stark online but haven't been able to find much other than a 5 Star healthgrade rating. He does approx. 8 extractions per month. Hes affiliated with all the top hospitals. Hes 60 and has been doing this for 33 years.

Again thank you all for your support. This website was a real treasure to find.
Renee

Whoopee

by donr - 2011-03-01 06:03:59

Renee: sounds like you got your head screwed on correctly now. Also sounds like you've grabbed the bear by its ears & have control. Keep working on it - all of it. I think I told you of my lead fracture. It occurred at an unknown time & we knew something was wrong, but no one could find it & not for lack of effort. I can recall a situation w/ a cardio, RN & an electrical engineer (me) huddled around an X-Ray looking for something. NOTHING! Then there were discussions as to what the interrogator was trying to tell us. Nothing. Then another session w/ a Medtronics tech - nothing. A session w/ my EP, his RN, another Medtronic tech an X-ray & interrogator print outs. Nothing. Then the EP had a brainstorm & ran some impromptu check & shouted "EUREKA! I found it!" He proclaimed a fractured lead! Finally two weeks later a totally unrelated radiologist found the fracture - a big gap between the two ends halfway down the vein to my heart. It had been hidden by the other lead & the angle I was standing when they took the X-Ray.

So---what happened to you is not unusual.

Stark: 8 extractions per month - that's 96 per year. Easily approaches the 100 mark. Who's gonna quibble over 4? How long has he been performing at that rate? Can you find out how many of his procedures are successful? Where are you if his success rate is about 30%? Not too well off! Have you checked the state medical board for complaints? They may have a treasure trove of info to help your morale. What's the source for the "..top 3 in the nation" rating? Rumor or some organization? Go to USA Today & check for hosp ratings. Several yrs ago they posted them for a bunch of hosps & had a site you could go to and check out any hosp in the country. If you know where Stark has privileges, you can check out his performance record. from an impartial group that uses real statistics. I was able to check out my primary cardio that way & found that he had a darned good record of keeping people alive!

Sounds like you finally met him. Did he treat your head in addition to your heart? It sure sounds like it.

This is not a e-slap , but a checkup on your progress. Sounds good! I'm pulling for you on 8 March. You are doing just fine.

Don

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