Pacemaker lowered in pocket

Hi

I got my 6th (I think 🤣) pacemaker in October. 
come February (about 4 months after device change) the same leads were used. I noticed that my pacemaker has gotten lower (maybe an inch or a bit more) I can also see the outline of one of the leads from under my skin near the scar (which wasn't visible prior)

this has never happened with any of my other devices.

this last device change the doctor said one of the leads had damage to the insulation in an area. He put a silicone sleeve in that area and stitched it. 
again never had this happen before... sounds like jury-rigging to me?

i meet with a new EP (not the one that did the latest procedure) end of March.

has this ever happened to anyone else?

I am keeping an eye on where it is now to make sure it doesn't keep lowering. 
 

thanks!

Amy 


6 Comments

Movement

by piglet22 - 2024-02-29 05:30:42

Hello

I'm not surgeon. The closest I get to creating pockets is inserting slips of garlic into lamb roast.

I would be concerned about what you describe and hope you get it checked.

Normally, some "slack" is factored into leads and I can see distinct loops in leads on X-rays on mine.

A movement away from the sub clavicle vein could put extra strain on the leads by reducing the slack.

It's not unusual to see or feel the leads or connecters.

Pacemaker leads are of a type called a coaxial lead used to shield delicate signals like cardiac or pH from leakage or interference.

Coaxial leads don't like tight bends and can introduce noise into the signal.

I would also be concerned about the reported damage presumably to the outer sleeve or sheath which has a difficult job to do.

It has to be long lasting, flexible, inert. Silicone or Teflon type material would be used, probably silicone.

Silicone splits and is difficult to repair. You can use a sleeve but it's not easy.

In industrial situations, you would use a self adhesive heat shrinkable sleeve, but where possible, it would be replaced, not repaired.

You see sleeves being used in operations to repair tears, but a cable is different to an artery.

There are probably several layers in the PM lead, for protection, insulation and electrical shielding and in my opinion, in something as critical as a PM, I would want to know that this was an acceptable procedure

There might be a perfectly good reason why the PM might move and an inch might not be important, but when coupled with the damage, I would want some reassurance that all is well.

Watch for any symptoms

by Gemita - 2024-02-29 06:38:06

Amy, Piglet has given you lots of helpful technical information and I will just give you some practical thoughts.  I haven’t experienced a device change yet but after my only implant there was some movement of my device, more towards the left armpit, but this has in no way adversely affected my pacing experience.

Just be aware of any new or worsening symptoms.   If a pacemaker lead gets pulled out of position or the lead between your pacemaker and your heart breaks, impairing communication between the electrodes and the generator, it will most definitely cause symptoms.  If you remain symptom free, that should be a reasonable indicator that any movement in your device has not caused real harm, but of course I am glad you will be getting some checks to make absolutely sure that your leads and device are still in a good position.  Please let us know how things go? 

PS please make sure the device or leads do not actually break through the skin - that would be serious and need immediate treatment

shifting

by Tracey_E - 2024-02-29 11:04:40

With the lead, it sounds more to me like trying to squeeze out a bit more life than jury-rigging. How old are these leads?

It also sounds like when they stitched it in place, it didn't hold. You might want to ask for an xray to document where it is now and get someone to look at it to see if erosion is a potential problem. They may be able to go in and reposition it again. My last one shifted, also. It's annoying, not painful, so I opted to leave it alone rather than reposition.

Lead sleeve

by Lavender - 2024-02-29 11:30:04

Yes we had someone post within the past year of a lead that was covered by some kind of insulation sleeve rather than extract a fraying lead.  I looked briefly for the post but can't seem to find it. 

Lavender

by piglet22 - 2024-02-29 11:51:06

I do remember reading it.

You have to keep in mind that there is a connector that is usually larger than the lead.

A sleeve can be expanded to go over the connector, but it needs to be a moisture-proof fit.

For what it's worth, the applicator is similar to that used, how shall I put it, to reduce friskiness in new born male lambs.

Fraying lead repaired

by JaneJ - 2024-03-01 04:10:29

I had some degrading present on my atrial lead during my last replacement surgery.  They used a medical grade adhesive material to repair it.  They applied the adhesive, let it dry, then closed me up.  So far so good with the quick fix they provided.  Leads all seem to be in good, working order.  That was about 7 years ago.  I'll have another battery replacement coming up this year, so we'll see how things look with the repaired lead at that point.  Must be some super glue they use...wow!  😂

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You get your device tuned-up for hot dates.

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