Calcium in PM pocket

Someone posted a message here a week or so ago with a question regarding a lot of calcium his doctor was pulling-out of the pocket with his fingers during his device replacement. I responded that I never heard of such a thing and thought maybe it was a problem with his device that caused it, but that I really had no clue. I looked for that post so I could update my response, but it is gone. So hopefully he will see this.

So guess what? I am laying on the table during my 1st procedure this past week as the Doc pulled-out my old device. I heard his assistant ( a young doc) ask him; "what are we going to do with all that calcium?" So I an thinking OMG, and immediately asked; "what's-up with the calcium". The Doc responded; "we see that a lot more so with older devices and leads". Then he added; " it is produced from a reaction between the device and your body, but nothing to be concerned about." They then cleaned it out and moved-on! I guess that I knew nothing about this in the past, because I was out for all my other PM replacements and the Doc's never said anything.

Wow! This was a real "live and learn" experience for me! 

 

Sincerely,

Dave

 


10 Comments

Calcium in device pocket

by Gemita - 2024-03-17 11:25:30

Dave thank you for your post.  Yes, I do recall the post from a member about his surgeon pulling out calcium with his fingers.

I see the body's "foreign body response" to a device can result in significant fibrosis and even calcification, see link about dystrophic calcification (calcification occurring in necrotic tissue) of a pacemaker pocket and the reasoning behind adding a bio-envelope at generator change.

Dystrophic calcification can occur even if the amount of calcium in the blood is not elevated, in contrast to metastatic calcification, which is a consequence of a systemic mineral imbalance, including hypercalcemia and/or hyperphosphatemia, that leads to calcium deposition in healthy tissues. 

Your doctor’s response ”we see that a lot more with older devices and leads:  it is produced from a reaction between the device and your body, but nothing to be concerned about"  is revealing and significant I think for pacemaker problems perhaps down the line - erosion of pocket for example comes to mind.

We have learnt a lot from your procedure Dave.  I think this finding is significant since calcium build-up could cause problems with lead electrodes/tips becoming calcified and not transmitting signals adequately, although I believe we have steroid eluting lead tips to help prevent this from happening?

Thank you for this really useful information Dave.  The things that are not said can be so revealing!

https://www.jacc.org/doi/10.1016/S0735-1097(22)03484-2

That is interesting

by Good Dog - 2024-03-17 13:26:57

Thank Gemita! I had not yet even thought about researching this issue, so your link was very helpful. I am not sure if I should be concerned or not. Obviously, the problem has not yet done any damage to my 37 year old lead. The doc said that since we are able to continue using that lead, we may put it in a museum someday! 

He also told me that he put my PM in an antibiotic envelope. I have never had an infection with any of my previous devices, so I assume they are just using these routinely, but I am not sure.  Also, this is the first time I have not had a bandage. Just the steri-strips. First time I wasn't knocked-out also. Lots of firsts after living half my life with these devices.

Thanks again for the info and comment!

Dave

37 year old lead

by Gemita - 2024-03-17 13:59:18

Yes that is quite an achievement and the fact that it is still working tells me that the environment in which it resides cannot be so hostile.

No don’t worry about anything Dave - just make a full recovery!  Continue to remain happy, active and enjoy a healthy lifestyle.  You have such an easy going nature and that is to your benefit.  Don't ever change.

I hope your new device is working well and that it will have some useful new tools should you ever need them

Always more to learn

by IrishToast - 2024-03-17 16:40:35

Thank you Dave and Gemita. There is so much to learn, but the more we know, the better we can help ourselves and others because we are the ones with the experience living with what the experts do to help us. The link about cell-derived matrix was quite interesting; however, the cell growing technology is very concerning to me when it involves human embryos. I want no part of that brave new world. I would prefer to see this not needed in the future as they find new techniques and ways to prevent the devices themselves from causing scar tissue and calcium buildup. 

Calcium deposits

by Julros - 2024-03-18 01:56:14

Only slightly related, but I was diagnosed with calcium deposits in both of my shoulders about 12 years ago (way before I recieved a pacemaker). I was referred to an orthopedic surgeon for frozen shoulders. I had xrays done and the calcium showed up. The orthopedist called it calcific tendinitis and said it wasn't unusual in women my age (mid 50s), and it would go away on its own. He tried a cortisone injection for the pain, but it didn't help. He offered to administer anesthesia and then "break my shoulders open" by manipulation. I chose to see a massage therapist instead, who was able to loosen my shoulders with massage, Graston tool, and cupping. 

Before treatment  I was unable to raise either arm above my shoulder, and couldn't raise my left hand (dominant side) above the level of my waist. 

Calcification

by Amyelynn - 2024-03-20 01:55:05

Very interesting guys...

I was diagnosed with SVC syndrome 3/2023 with a 90% blockage at my SVC. I had angioplasty/ballooning done of the 3 blocked vein areas. however can no get a stent because of the leads.
My radioligst told me the SVC syndrome was caused by my 25  year old  abandoned leads. He also told me I had a lot of calcification. I had no idea at the time what this meant. 
He reccomened I meet with a lead specialists to discuss lead removal. I have yet to find one who is willing to take them out. Not many out there who are skilled enough to my comfort (and accept my insurance) 

Thanks for sharing the article and everyone's info I am going to do my research to understand more exactly what this all means.

take care everyone!

Amyelynn ?

by Good Dog - 2024-03-20 08:13:24

Amyelynn, if you don't mind me asking (you can PM if you prefer), what are your symptoms with your SVC Syndrome? How many leads do you have? I find all of this interesting too. I had a discussion with my Doc about this and/or a very similar issue. I guess that I am wondering if your problem is the lack of blood flow on your left-side or something else?

Thanks,

Dave

Hi Dave

by Amyelynn - 2024-03-20 15:40:10

I'll try to shorten this...

I had my first pacemaker in 1998 age 12. In 2008 I had been getting light headed not feeling well and went to my cardiologist and found out one was no longer working and the other was faulty also.

the doctor tried to place new leads in on the same side (left) but couldn't pass them due to "stenosis" he abandoned the other two leads (now 26 years old) and placed two new leads and a pacer on my right side.

I found all this out about 2 years ago when I was advocating for years with many doctors about my symptoms I was having. So to try and figure things out on my own I got all my past records (and learned of the stenosis) I was told by a new EP Jan 2023 that stenosis with pacers is common but it won't get worse and I won't pass out (as I asked that question)

then I almost passed out one day in Feb while I was gardening...

found another new EP he gave me a referral for an interventional radiologist who ordered a CT scan. That came back normal so the EP said "it's clear from the CT that there is no blockage in my veins"

thankfully for the IR who asked me if I was still having my symptoms (which were worsening over 5 years!)

symptoms:

mostlys occurred when bending

face got extremely flush

pressure in head and neck

left jugular vein bulged like crazy

feeling of dizziness/lightheadedness when standing straight 

the IR then performed a bilateral venogram not expecting to find anything but wanted to 100 percent rule out a problem with my veins. He was shocked to find 90% blockage at SVC 80% blockage at left Brachiocephalic vein and 80% blockage at right subclavian vein. He ballooned all the areas etc etc. 

I have been feeling pretty good yet my cardio has not been the same since my latest pacer implant in October. 
the old EP mentioned something about rate optimazation? Not sure what that is.

meeting with new EP next week 

as I also have been noticing some strange issues in my rig he armpit/vein area... again I have gotten ultrasounds for the veins and they say it's fine but hard for me to trust ultrasounds and in the past I had them and was also told it was fine. 

so yes the old leads along with scar tissue and calcification causes restricted blood flow. Lots of times I guess your body will grow collateral veins which I guess there was a bunch in my neck but via the benigram he could see a lot of blood flow was going up towards my head instead of towards my heart etc.

New study that came out

by Amyelynn - 2024-03-20 15:50:43

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9655673/

I recommend reading this study which makes me greatly concerned for leaving these abandoned leads in any longer and not having a plan moving forward to take them out (especially as they have already caused so many problems) 

You are correct!

by Good Dog - 2024-03-21 07:33:26

Thanks for that explanation. So my understanding is that you did develop collateral veins, but they are not carrying sufficient blood flow to the SVC. Based on my Doc's explanation, your situation is very rare. However, I don't claim to know that much other than what I've read and learned from him. I have to say that my Doc refused to move everything to the right side and said that is a bad idea. There are multiple reasons, but he said that he would extract before doing so. Given your young age, I am really surprised that your doc did that. I guess that I am wondering how much experience your Doc has as well as the kind of facility that he operates out of? I have found over the years that many Cardiologists EP's are sub optimal when working with young and long-term patients like us. Especially when it comes to extraction. Seems to me that your Doc should have referred you. I live near the Cleveland Clinic, but never used it until recently. I have done so, because for the potential of needing extraction; I wanted the very best. Also, my previous Doc was just not that skilled. 

I assume that you know that when selecting a doc for extraction you want one with a lot of experience. At least 100 under his belt. I don't know what kind of facilities you have where you are in Ca, but you should seek-out the biggest and best. People fly-in to the CC here and stay at the connected hotel, have their procedure and fly home. They care for cardiac patients from all over the world. However, that depends upon your available resources. Frankly, I am sure that Ca has some great hospitals. Although, my sister lives in San Francisco and she told me that Doctors there are all booked to the max and it is very difficult finding good care. It is a huge state. I am sure you will get it all sorted-out!

Please keep me posted and if I can help in any way, please do not hesitate to ask!

I wish you nothing, but the very best!

Sincerely,

Dave

You know you're wired when...

You have a little piece of high-tech in your chest.

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It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.