Lead Extraction after 20 yrs?

Hi, I am new to this group but doing research. I have had a pacemaker since 1978. I am on pacemaker #5 and on my second set of wires, of which one was implated Dec 1987; the other April of 1996. My old wire is using up my battery life fast - I am told that the next time I will have to have a new wire..possibly two. In researching, I've found this is life threatening to remove the wires. I have one set of wires that have been abandoned on right side; the other wires were place in my left side. I was told that if they can squeeze a wire between the current wires - if there is no scar tissue, they will do that. The alternative is they do open heart surgery and sew the lead wires on the outside of the heart. Has anyone had any experience with regard to this? Also - read that regarding lead extractions, the Dr's success rate is based on numbers and training. Who has this experience? Does anyone have any information regarding any of this? Let me know. Thank you.

8 Comments

Lead Extractions

by Pacemaker5 - 2012-03-07 05:03:12

Thank you to both of you for your comments. I would very much like your interview questions as from what I'm reading, not everyone can do these procedures with success. I'm gathering that my physicians don't really think they can remove my lead wires without harm -- so thinking to place on outside of the heart. They said placement on the outside of the heart is not the most optimal, but in my case may be the best solution to the old lead wire problem. I am thankful for modern medicine, just want to make sure my surgeon is knowledgeable, qualified and has plenty of practice.

Later tonight

by donr - 2012-03-07 06:03:03

I'll send them to you. Gotta run for a errand or two.

Don

Lead Extraction

by donr - 2012-03-07 07:03:55

PM5: I have not had one - but nearly had to. My first EP - about 5 yrs ago when I faced it, told me he wouldn't do it because he was not comfortable doing the procedure. They apparently have a ring that they thread around the wire where enters the vein; the ring has a laser that literally cuts around the lead, freeing it up from the tissue holding it in place. Sort of like a roto rooter for the vein.

It is a risky procedure, compared to threading new wires into the vein, but is performed frequently & with a reasonably high success rate. I now have a new EP - not because of anything the old one did, but because my primary Cardio realigned his practice w/ another major clinic as associates & picked up another EP. New guy does lead extractions all the time & likes doing them. I THINK he does a hundred or so per year. When he & I discussed the procedure about two yrs ago, i rec'd the impression that he gets referrals for the procedure from other EP's in the area. Based on my experience facing the job, I developed a set of questions that you should ask if interviewing an EP for the job. I have given them to a couple people here. If you would like them, pls let me know. e glad to pass them on to you.

I think someone here has had a lead removal that was successful & not much more traumatic than a PM implant - at least from the standpoint of someone who is completely zonked during a procedure.

Don

Hi, I'm on DF#5

by Laben - 2012-03-07 11:03:30

In '93 I had a rather large DF implanted in my left side below the ribs and seven years later (on DF#2) developed infection around the leads that had to be removed. For this my cardio dr. sent me to a specialist who pioneered a lot of techniques with troublesome leads. He has since retired but he is doctor Charles Byrd who practiced in Ft. Lauderdale, Fla. He extracted the two infected leads and replaced them using an incision between ribs on my left side while placing the new DF on the right chest area with it's own incision. He had a hard time getting through the scar tissue surrounding my heart but was able to get the two leads placed from outside the heart. He did not open my chest as in open heart surgery. It worked out well and when DF was next changed, due to his "fancy work", I was again sent to him and he added a third lead and got my heart beating so much better. After his retirement I have had DF changed locally. I,m making this to long but perhaps you could find a surgeon who is doing the type work of Dr. Byrd. Best of luck to you! .........Laben

Stratton NB

by donr - 2012-03-08 12:03:17

PM5: I just looked up the town you live in. I thought I lived in the middle of nowhere! I'm only 65 miles from downtown Atlanta, GA.

I have flown over Stratton before - several times - on the way between Denver & Chicago. We drove from Rock Island, IL to Denver once & drove through that country. I realize the miles of nothing but miles of farmland & small communities out there. I see you are not too far from Colby, KS. We were going through there in about 1969 and lost a water pump in our car. Spent two days camped out in the Colby city park while I awaited a new pump at the local Buick dealer & did the replacement next to an old school bus full of flower children.

I can see how you would have cardio's out there who aren't comfortable removing embedded leads. Looks like your best bet for an extraction would be Denver or Omaha, where there would be a major med ctr associated w/ a teaching hosp. This is not a trivial procedure at all. Compared to the number of PM's implanted, this is an uncommon procedure, so there are relatively few EP's qualified to do it.

Considering that they do not have to open your chest up to do it, I would say that the procedure I have outlined is much patient friendlier than having the leads outside the heart.

The best to you on this.

Don

Lead Extraction Interview

by donr - 2012-03-08 12:03:33

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

Interesting Read

by donr - 2012-03-10 10:03:50

You said you are doing research on the subject of lead extraction. Want to read a scholarly work on this?
Below is a cut & paste of a comment I just wrote a few minutes ago. Thought you might like it. Really addresses a lot of the issues you face. It was not a trivial search to find it, believe it or not. It finally came up when I Googled the subject "Pacemaker leads extraction mortality rates." morbid, I know, but I found nothing that addresses the risks of PM lead extraction. This article covers it all & is at odds w/ some of the questions I posed in my previous comment to you. I developed my list independently of the web, so it is a different blind man's description of an elephant . Fortunately, we disagreed in details, not substance.

Don

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

Enjoy!

Cleveland Clinic

by Mary1998 - 2012-06-01 01:06:34

I believe I have read on the internet several articles about the Cleveland Clinic being in the lead as far as lead extractions go. You might check them out, too.

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