PM Extraction and ICD Insertion

Hi. Firstly, Happy New Year to you all.

Secondly, it has been a number of years since I have posted on here. I had my pacemaker put in in 2011, after ablations for arrythmias. I have been doing great. Got a full time job again, my children have grown up into fine adults....life has been great. UNTIL.....

In 2012 I started having episodes of ventricular tachycardia (VT). My previous arrythmias were all atrial prior to that. Over the years I have had occasonal episodes of VT, only lasting a few seconds and sometimes I didn't even know - they showed up on my PM checks.

Last Friday I collapsed at home with two episodes of VT. They happened one after the other, literally. Hubby called an ambulance. Taken straight to the hospital where all my cardiac care is done. I am in the UK, by the way.

To cut a long story short, had my PM downloaded yesterday which showed my heart rate during these two episodes on Friday was 300bpm and the VT was an irregular rhythm this time (I think previously the VT rhythm was a regular VT rhythm). I think you can get different types of rhythm - monomorphic or polymorphic. I am not sure. VT is new to me.

My EP said yesterday that as I am only 55 and have potentially decades to live, as I can't tolerate meds like beta blockers etc (hence my previous ablations instead of meds), he recommends extraction of PM leads and removal of PM - and replace with ICD system.

For me this has come as a big shock. Having been really well for a number of years, after a rough time when I first got my arrythmias in 2009, ablations, PM in 2011 - I've been doing great until now.

My PM download showed I have had 6 episodes of VT since June, which I didn't feel. The two episodes on Friday I definately felt and was almost to the point of blacking out. Fortunately it stopped by itself.

My questions are - has anyone been through lead extraction and PM removal then ICD implant? I was already aware lead extracion is tricky at the best of times. They have told me the risks. But they have also told me the bigger risk is having a cardiac arrest with the VT! So I know I have no choice really, I have to have this done. But it is scary. They tell me it will all be done under general anaesthetic which is a relief as my ablations and PM were all done while I was awake and that was certainly an experience!

My other question is what is it like living with an ICD? I think I have an advantage in that I am used to the PM, used to the things to avoid, used to pacing checks etc. But it's a whole new ball game with a device that can shock you.

They have given me loads of info to read. They have given me a "dummy" sample of the ICD device. It is bigger than PM and heavier. They told me that is because it has to do the pacing and the shocking, so more electronics in the device itself.

They told me this is urgent and they plan to do this in a few weeks time. Lots to take in when my EP and head of pacing went through all this with hubby and me yesterday.

Any info would be much appreciated.

Also, I am not sure if my friends Donr, Inga and other people who knew me are still on here but if you are - "Hello from Janey in UK".

Best wishes

Janey

5 Comments

Good Questions

by Beagle - 2018-01-09 07:56:31

You’ve asked some good questions. I will be in a better position to answer later in the week. I’m heading in this morning for an EP Study, possible ablation and probable device upgrade to a CRT-D.

My CRT-P was implanted in July of this year. At the time, I wasn’t experiencing any abnormal arrhythmias, other than frequent PVC’s. Episodes of v tach started in October and have since increased in frequency and intensity. Adjustments were made to my pm, which hasn’t worked, nor has med changes/adjustments. We’ll see what today brings.

I don’t think I will need a lead extraction... I was told that they will need to add a lead and change out the device. I’m not too worried about getting shocked... it may be uncomfortable, but the alternative is to risk cardiac arrest and sudden death. 

I wish you the best and will post an update and hopefully have some useful information for you.

Bob

Living With an ICD

by Grateful Heart - 2018-01-09 11:10:24

I would imagine....Similar to living with a PM.  Yes the device is larger and heavier. 

Just to give you some reassurance, I have had my CRT-D for 9 years and have never been shocked.  There are so many settings in these devices.  For example, there is a setting to pace you out of VT before your device would shock you.  I believe mine is set for 12 seconds to shock.  I've been paced out and back to normal a few times.  Once it occurred during a high intensity exercise class which I no longer take.....but I still exercise.  None of us want to be shocked of course, but as you know, if it happens it is a life saver.

Just like with a PM, you are aware of it in the beginning and with time, you just continue to live your life. 

If you have questions, feel free to ask.  You got this Janey (and Bob).....like you said, you do have an advantage.

Grateful Heart 

PM to ICD

by islandgirl - 2018-01-09 16:00:54

I was paced for SSS for a couple of years and had an out of hospital sudden cardiac arrest July 19 2016.  I am fortunate to have survived with no deficits, and the cause is unknown. I was upgraded from a PM to an ICD.  Mine was done under heavy sedation, but the EP made the comment they had to give me so much that it was like general.  My ventricular lead was replaced for the ICD.  My EP is experienced at replacing leads.  Mine was placed in the same pocket as the PM, subpectorally so it doesn't interfere with my activities.  It's important to know that if they put in an MRI compliant ICD, you cannot have any loose leads and your leads have to also be MRI compliant.  Did they give you a life vest to wear to protect you?  

After the SCA my EP contacted Medtronic and I had been having Vtach episodes, which weren't showing up on reports.  I have had my ICD almost 18 months.  I've had no shocks, and the EP feels as though the meds I take are the best to protect me.  I've had occasional runs of Vtach, and the ICD has paced me out of the arrhythmias, avoiding a shock.  My EP says 'it's doing it's job'.  I always dread a shock--and I'm sure that's normal.  He has the voltage (?) set high since it was so hard to revive me and I went very quickly from ventricular arrhythmias to flat line.  

Realize you don't have a choice.  You need that protection.  The SCA has been very traumatic to me, both emotionally and physically (even though I don't remember anything and I can't believe it really all happened to me). It's also been traumatic for my friends and family.

Ask about a life vest to protect you while you wait.  

Good luck!

 

 

 

Got the t-shirt

by ROBO Pop - 2018-01-09 18:27:50

Been there...seriously don't make more of it than there is, you'll make yourself crazy. You've already had a pacer and honestly an ICD isn't any different to live with.

As far as lead extraction, mine popped right out after 10 years, no biggie. They do lead extractions all the time, and I've never heard of serious complications from one. At least in most cases in the US, they have a cardio-thoracic surgeon on standby in the event of issues.

As somebody else said, few people ever get a Jesus Jolt from their ICD, its a safety backup, and as a frequent flier I can attest the shock is no big deal if you do get one. Its a quick thump and done. Beats dead, or at least one would assume.

Thank you

by Janey L - 2018-01-16 07:55:04

Thank you for all the replies above. Your information and experiences have been really helpful to me.

I have got over the shock of needing an ICD now and I am focusing on the practicalities like preparing for hospital admission.

On Friday this week I am seeing the EP who will be doing my PM & lead extraction and ICD placement. There are only 2 EP's qualified enough to remove the PM leads in my hospital so one of them will be doing my procedure. I am not sure when yet but hopefully I will find out on Friday.

Thank you again - I will keep you updated.

Best wishes

Janey

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