Misplaced leads

Has anyone had any experience with misplaced leads?  Can leads be ‘slightly’ misplaced? i.e. still making good electrical contact with myocardium but protruding enough to irritate the pericardium?

CTscan shows my RV lead near apex but cardiologist noted “brightness of lead can cause some artifact about where lead actually ends in myocardium”.

My surgeon put in extra long leads to accommodate my athletics, but now I’m reading that long leads can act like a spring.  Has anyone had an issue like that?  When I sleep on my side I can feel my shoulder impinge on the PM and leads. Sometimes it hurts and then I get the heavy irritation feeling afterwards.

My doctor thinks I have chronic pericarditis even tho echocardiogram, ESR and C-reactive tests show no inflammation. The problem is that my symptoms are intermittent (some days I feel great) and that doesn’t fit with any usual diagnosis.  

Thanks for your input.



by Tracey_E - 2024-01-16 08:47:33

Yes, leads can be in a less than ideal position, still making contact and pacing but not in a good spot. Have you considered a second opinion? The leads can be moved relatively easily the first year, after that the scar tissue holds them in and it's a bigger deal to get them out. So, if you want to move them to a better position, that's your window to do it easily. 

RV lead placement

by crustyg - 2024-01-16 12:30:13

There's been at least one contributor here who's had a partial perforation from an RV lead.

The anterior wall of the RV is really quite thin, and the metal helix that provides mechanical fixation can easily cause trouble here.  The RV lead is meant to be fixed into the septum between RV and LV (and not RV anterior wall), and this is most easily proved with a lateral CXR - it's not possible to be sure with the AP/PA view during placement.

As your EP-doc says, CT is not always the best tool to prove where the RV lead tip has been anchored.

Very similar situation!

by Mae11 - 2024-01-16 21:13:55

This is a very similar situation as what I am currently dealing with. The leads being extra long, the CT not giving great answers, chronic pericarditis, even the lead repositioning! Wow!

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