Subpectorial implant/stimulation

Hi guys,

Been awhile since I last posted. In the past 6 months I've had an ablation to stop 2 to 1 pacing when my heart rate goes above 140 (goes to 140, drops to 70 for 2-3 minutes); didn't work. After multiple programing changes, had a lead revision to remove the v lead (the thought was that there was too much scar tissue at the tip) and to place pacemaker subpectorially for better protection. Xray the next am, determined not enough slack in lead, subsequent operation to lengthen slack. Went home the next day and experienced severe pm pocket stimulation 2 dozen times over 24 hrs. (set to bipolar, not unipolar so it should never happen). Went to EP, was told possible a-lead compromise when using the laser to remove buildup on leads during revision. Turned down power to a-lead. Helped but did not stop stimulation. After several more interrogations, including turning off all power options to a-lead, had operation to remove and replace all leads and pm. It's about 3 1/2 weeks post implant and I am still feeling pm stimulation at the pm, and strangely, sometimes the arms or other locations. I know it is not just muscle contraction as there seems to be a pattern to the stimulation in terms of beats. Has anyone else with a subpectorial implant had any stimulation issues? From limited googling, I'm thinking it may have something to do with the leads being to close to some nerves that is causing the stimulation.

Thanks,
Al

5 Comments

That raises another question

by ElectricFrank - 2010-01-06 11:01:34

What in the heck are you doing engaging in an activity where you might get in a life or death struggle when you have the heart condition you described?

Just wondered,

frank

Wow

by ElectricFrank - 2010-01-06 12:01:38

Reading your history gives me an uncomfortable feeling about whoever is making these medical decisions. To start with I've never hear of an ablation for 2-1 pacing where the heart rate drops. Ablations are usually to deal with extra beats. Removing a lead won't remove the scar tissue from the site either. With all that going on moving the pacer just to get more protection is asking for trouble.

Either the medical team is incompetent or they aren't telling you the whole truth.

frank

Frank

by BuddyOne - 2010-01-06 12:01:51

The way it was explained to me (by the EP and St Jude tech, who actually used to help engineer pms) was that even though I have heart block (bradycardia), blocked from top to bottom, signals can actually go the other direction. So what was happening is the pm would sense this and get caught in a loop, hence the drop. The ablation was done to eliminate the chance of it going into a loop.

You are correct in removing the lead wont relieve the scarring at that location. The new lead was placed at a new location, also changed from tinged lead (barbed) to a screw in lead.

Moving the pm subpectorial for protection was because of my job (law enforcement). The upper pec/clavicle is one of the 1st areas someone tries to grab when you are in a struggle.

Al

pecrorial implant

by doublehorn48 - 2010-01-09 08:01:49

I had two pm implanted . The first one would "jump" when I raised my arm to a certain level. Before the next pm was implanted I showed this to my surgeon and he said the pm was probably too close to a nerve. He moved the next pm and I didn't have anymore problems.

Frank and doublehorn48

by BuddyOne - 2010-01-10 04:01:10

I work in law enforcement because I love what I'm doing and have a passion for doing the right thing in helping others. And it pays very well:)

Like many, I believe the pm should not limit what you can do in life, as long as you know your own limitations. Even with the 3 1/2 years I had the pm under the skin, I've been able to do the same things I did prior to implant (except walking through airport metal detectors). With it implanted subpectorially, I do feel alot more comfortable with the protection that it affords me. Now if they can only figure out the stimulation.

Doublehorn 48

I talked with my EP and the tech from St. Jude about the possibility of the pm being placed near a nerve. I was told that they took the precaution to test the sight of implantation, to avoid any nerves. I go back next week and am thinking of asking to have an xray taken to see if it's possible that the pm shifted to where it is now near a nerve (compare xray to the post pm implant xray).

Al

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