Avoiding raising the arm and pulling out leads during sleep

Hello again,

PM newbie here, but third post. I really appreciate that this community exists!

I've seen the advise here against relying on a sling too much and staying mobile post op which makes sense. I'm curious though about how people sleep?

I'd usually lie on my side with the left arm straight up and under the pillow which isn't recommended at all. To make sure that I don't end up doing this in my sleep I've started sleeping with my left arm tied in with a sling like this https://www.amazon.co.uk/Wonder-Immobilizer-Dislocation-Subluxation-Compression/dp/B08FJHTWC.

I only use the arm loop and keep it loose, this prevents me from lifting the arm up while still allowing me to move the arm about. I've slept ok like this but would love to hear any other experiences of how people avoid pulling out leads in their sleep.


Pulling out leads...

by crustyg - 2023-07-07 15:23:16

..during sleep is effectively impossible.  As long as your EP-doc has used the correct length lead during placement (they aren't all the same length).

Modern leads have a small metal helix that actually screws into the heart muscle - and it's this, combined with the slack in the leads (see above) that stops the leads from pulling out during each heartbeat.

The real issue with pulling out leads is this: each lead is anchored by a wide collar at the top of your PM pocket, just before the lead goes deep and into your subclavian vein.  *IF* you start really stretching your arms up and wide then this vein does move upwards and outwards and will tend to pull on your leads away from the heart.  A very, very few contributors here have had this happen to them.  Brachiating, really wide-spaced pull downs, or wide-hands bench presses can do this.  But not in sleep.

Electrophysiology tell me that it's wise to avoid too much nighttime pressure on the wrists if you're at risk of carpal tunnel syndrome.  Putting a hand up underneath your pillow is not adivsed.

You're far more likely to cause problems for yourself by restricting arm movement than by overdoing the whole 'reaching up after heart lead implantation' activity.

Ditch the sling

by Gotrhythm - 2023-07-07 15:32:03

Do not use the sling for longer than 48 hours post surgery. Restricting the movement of your arm and shoulder for longer can lead to "Frozen shoulder" which is very painful, and crippling, and takes a long, painful time to recover from. But most of all, it is an absolutely unneccesary, easily avoided complication of pacemaker surgery

But what about the danger of pulling out the leads? you ask.  Everyday that passes, your body is building scar tissue around the leads. Everyday, the leads are a little less likely to dislodge until after about 6 weeks nothing short of surgery can pull them out.

For now, sleep in any position that is comfortable. I suspect your habitual position of left arm under you head will be quite painful for a while, so there's little need to worry about it happening accidentally.  Most people find that sleeping on the left side is practically impossible until the swelling has gone down, and they develop strategies for piling pillows to make a sleeping position that is workable. Some recommend sleeping in a recliner.

For the first week or so, use the arm/shoulder gently, but don't make an effort to artificially restrict movement in that area.



Couple of Nuggets of Info

by Penguin - 2023-07-07 16:59:26

This answer re: how do you sleep comfortably following an implant, feeds into your previous post and the awareness of v.pacing. 

I forgot to mention that if you are feeling v.pacing as 'electric shock sensations' particularly at night, it may be that your current has been turned up too high.  Pacing clinics routinely set the current deliberately high post operatively to encourage the leads to bed in. If you feel v.pacing as electric shocks, you may be feeling this higher current.  It's particularly bad when you lie on your LHS in bed which seems to make the pulsing stronger and more obvious as it pulses through this area.

If this is a problem for you speak to your technicians at the pacing clinic and see if they can turn the current down a bit for you.   If you can put up with it, it's less uncomfortable if you sleep on your back or  RHS. 


by Tracey_E - 2023-07-08 10:59:42

I found it helpful to hug a small pillow. I'm a side sleeper, this kept me from rolling onto my sore side and arm mostly down. As crusty said, odds of doing any damage from raising the arm in sleep are virtually nil. Some doctors don't even restrict arm movement after the first two days.

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