Surgery for new lead and possible 3rd lead

get another opinion

by Tracey_E - 2018-12-19 10:21:46

Is the doctor a cardiologist or electrophysiologist? I had one cardiologist- one I'd been seeing for 20 years, adore and trust, but he didn't have other patients like me- suggest the same to me. My feeling is always less is best and leave well enough alone so I did a lot of research. The ep I'd been seeing said my EF is great so he didn't feel the third lead would be helpful. Then I went to an EP who specializes in adult congenital so sees literally hundreds of younger, long term paced patients, and he said vehemently no way. He believes there's limited evidence it prevents heart failure in heart block patients, and that if someone is paced more than 5 years with out a loss in function, he rarely sees them lose function later. For me (paced since 1994) he doesn't feel it's much of a long term risk anyway, so why add more hardware to prevent something he doesn't think I'm likely to have a problem with. 

Can they add a new atrial lead or are they talking about extracting what's there and starting new? If they are fixing the atrial lead plus adding the extra ventricular lead I'm going to guess extraction because it's unlikely 4 will fit. Big difference in the surgery . If extraction is on the table, find someone who does a minimum of 100 a year, even if that means traveling. 

Do you use the atrial lead? Ask how much you pace with it. Many with av block don't use it at all so ask if turning it off for now is an option, then deal with it when you need a new battery so there's one surgery and you have more time to research your options and think about what you want. That's what I did when my lead went bad, waited it out until the next replacement. I chose to add a new lead, cap off the old one, and not go to a CRT. That was in 2011, my EF is still great, my other original lead is still working.  

got mine last year

by dwelch - 2018-12-19 11:53:30

31 years with pacemakers.   complete heart block like yourself and TraceyE.  after say 15-20 years is when they should start worrying about the effects of one ventrical lead, they should start doing echocardiograms every year watching your EF, Ejection Fraction.  When that gets to a certain level, well under the 40s in my case, they decided it was time.  We had been watching this for many many years.

My opiion on this is that down the road yes, biventrical pacer.  Right now, keep your leads to a minimum, enjoy the smaller pacers.   When your EF or any other data shows it is time, then it is time.  Dont start tossing them in just because.  By that argument why not get an ICD just in case...down the road...

This is of course between you and your doc...I broke a lead early on too.  I have four leads on one side, lucky that they all fit.  three I am using and one that I am not.

Biventricular leads

by Selwyn - 2018-12-20 07:21:32

If it isn't broken don't fix it! To have a lead "just in case" puts further hardware into you to go wrong, along with any complications of the procedure. 

The indications for biventricular pacing are predominantly to do with meeting thresholds of reduction ejection fraction, ie. the ability of the heart to pump (t he indications for biventricular pacing are as follows: Left ventricular ejection fraction < 35%, a QRS duration of > 120 ms and New York Heart Association (NYHA) functional class III or IV with optimal medical therapy.)

At present I have a partially functioning venticular lead that is draining the battery. Luckily for me I don't much use my venticular lead and so at present I am just on 'watch and wait', with PM checks every 6 months. Clearly, all hardware has a 'shelf life'. Why not have a brand new lead put in, if and when the time arises? You should meet the criteria for this (as stated above).

bivi pacing

by Rock-N-Roll - 2018-12-21 12:08:08

Resynchronization form a bivi pacemaker can improve your EF quite a bit. My husbands heart was failing and his EF had dropped below 30% so they replaced his pacer put in a 3rd lead and his EF is now greater than 40%. But i agree if your EF is normal and you have no signs of changing condition less is best. My EP specialist stated that with a normally functioning heart and a normal EF greater than 50% there is only a 5% chance that you will ever need a third wire for resynchronizing. Hope this helps.