Fixed length of pacemaker leads

I am not a happy pacemaker wearer and I think this is because I was told that I needed one withoutever experiencing any symptoms and there is no evidence from my 6 monthly checks that it has ever "kicked in" in "anger".

I am an active 50 something, I still play football (soccer) and I mountain bike. My initial fitting was sub-dermal and was a real pain, so I had it re-fitted beneath my pectoral muscle.  This has been excellent in many ways, I can't find the pacemaker without really pushing hard on my chest but the lead bundle has worked it's way through my chest muscle and is now just sub-dermal.  I have been advised not to go for a further operation until the pacemaker is changed because of increase in infection risk.

I asked why the leads were so long and was told that they had to be designed to fit everyone, be you 7 feet or 4 feet tall, and that it would be too expensive to have different lengths of leads.

Think about this for a minute.  Can it really be that expensive to have a range of lead lengths?  Can it really be that healthy to have to roll up the excess lead and use someone's body body to store the excess?

Perhaps pacemaker designers should have to wear one.  I suspect there is a similar issue with the developement of smaller sized units.  We are (usually, I accept that I am an exception) too compliant and grateful to actually ask for what we want. 

I think that Pacemaker club should open up a dialogue with manufacturers so that our needs and preferences can be fully taken on board.  I am sure that this would be a win-win situation that developers would welcome.

Is there currently way of making representations? 

 

7 Comments

wow

by The real Patch - 2017-08-25 14:59:33

aren't you the pleasant one...

If your medical condition did not justify a pacemaker, your healthcare provider in the UK would not have approved the cost of the device and surgery to implant it. I don't know what your problem is but the medical community determines what conditions should be treated with a pacemaker.

The leads come in several lengths, I believe it's 4 different lengths. There is a simple reason you don't want the exact length from your device to the heart wall...the leads would pull out anytime you extended your arm . They select the length best for your needs and the excess length is loosely looped under the device so that anytime you move, excess wire feeds out so little tension is placed on the end of the wire where it attaches to the heart.

I think the pacemaker club's job is to provide peer to peer support to one another, not dictate engineering design to medical suppliers.

Fixed length of pacemaker leads

by Claret - 2017-08-25 15:49:55

Are you for real? What better way to provide support than engaging with (not dictating to) manufucaturers, suppliers, purchasers?  I am not talking about going to war or falling out with them.  Thanks for your support.

If you saw the size of the bundle that has worked its way out then you would realise that it is not about allowing leeway so that it isn't put under strain.  Perhaps in America you have 4 lengths available but it would appear that the NHS buys a 1 size fits all job lot.

 

slack is good

by Tracey_E - 2017-08-25 16:02:02

If there was no slack, the leads would not be as secure. If NHS is only buying one size, that's an NHS issue, not manufacturer. 

Are you pacing 0 or <1%? Big difference. Why did you get it? If you were having pauses, kicking in a few beats here and there will keep the heart going, keep us from passing out. It can still be hundreds or even thousands of beats but statistically show up as <1%.

Lead Length

by IAN MC - 2017-08-25 16:34:00

Here in the UK there is absolutely no way that only one length of lead would be used as part of some national cost-cutting policy.   We are all different heights , shorter leads are fitted in children although carefully calculated allowance has to made to allow for their future growth.  There is a limit to how much slack can be tolerated.

The Medtronic Advisa which I had fitted is available with lead lengths of 35, 45, 52, 58 , 65 and 85 cms.    I had a conversation with my cardiologist re the different lengths of lead during my implant  procedure . It does annoy me to read suggestions that  in the UK we are receiving sub-optimal care when it comes to PM implants.. WE ARE NOT !

If you have encountered a local problem, Claret, then that is unfortunate but it is not a national NHS problem.

Ian

 

Slack

by Terry - 2017-08-26 13:02:33

Leads are provided with an "anchoring sleeve" to anchor the lead so that it won't slip to add more or less lead within the veins and heart. Slack in the pocket has nothing to do with required slack within the vasculature. There remains a lead length that allows the implanter to connect the lead to the pacemaker before looping it around in the pocket. This allows for future lead length for disconnecting and connecting a new pacemaker when the battery is used up. Just be thankful that you are paced less than 20% of the time, because suspect the lead is located in the apex of the ventricle or any other place that bypasses the cardiac conduction system. That can result in ventricular remodeling and risk of heart failure and atrial fibrillation according to studies - Google His-pacing.org. 

lead lengths

by Yeasin - 2017-08-27 02:00:03

Thank u all. I had no idea about length of leads! Now It is clear to me that different sizes of leads are available and the cardiologist would decide which size is required by his patient.

Lead Lengths

by Claret - 2017-08-29 14:47:04

I stand to be corrected on availability of lead lengths in the UK and I certainly am not applying that we get second rate services.  I believe that the National Health Service is the best health care system in the world despite its problems and current challenges.  However, there are real problems and challenges as we all know many of which the public are not aware of (I am friendly with several Doctors who work in the NHS).

With regard to lead lengths, the advice I have been given personally is contradictory to the availability of choice.  I have been told that the "bundle" that has worked its way through my pectoral muscle is excess rather than slack and this is clearly the case.

Moving on to the level of pacing that I experience, it is complicated.  I had the pacemaker fitted for Heart Block but I have a low resting heart rate which has never been problematic. My heart rate drops naturally drops below the level at which pacing occurs, so it is difficult to assess relative to heart block.  It has been droped from 60 beats per minute initially, to 55, and now to 50.  The percentage pacing has reduced each time.  My resting heart rate is in the 40's when I am at my fittest.

I have also read that there is a growing belief that the traditional view that the healthy range is 60 to 100 beats per minute may not be valid and that the healthiest range is actually 50 to 70.

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