Atrial Lead Replacement

I've posted earlier messages about clavicle crush and twitching muscles...we finally got an answer. My atrial lead wire insulation has been worn down due to pressure and grinding from my clavicle. The chest xray clearly shows a 1/2 inch portion of my lead wire exposed without any insulation. When my pacer would detect a need for atrial pacing, the current would stop around my left pectoral muscle, causing the pacer pocket and surrounding muscles to violently twitch - sometimes visible though my clothes. Anyways, my cardiologist who implanted my PM in April immediately scheduled a lead replacement surgery. I'm not confident that he is the best surgeon for me, so I'm getting a second opinion this week. I spoke with the new doctor over the phone and she told me that if she agrees that I need a new lead, the surgery will be needed asap.
Has anyone else had a similar experience? I'm worried that this surgery has a higher risk than the initial implant surgery. What will the recovery period me? Will they leave the ruptured lead wire in my subclavicle vein? Take it out? Where will the new wire be? Risk of this happening again?
Sorry for all the questions! I'm worried and just didn't think I would already be dealing with complications.

My pacemaker (St. Jude's) was implanted on April 30, 2008 for dysautonomia/orthostatic intolerance. I am active- working out 4 or 5 times a week...23 years old.

I appreciate any advice, stories, opinions...anything!
Thanks,
Brooke
Alabama

2 Comments

Lead Replacement..

by chip - 2009-01-25 02:01:26

Hello mbvkd,

Sorry to hear that you’re having such a problem.

While I didn’t have a situation like yours; I have had my atrial leads replaced and revised so I can offer you some input.

First I’m glad too hear that you are getting a second opinion. Far too many people rush into surgery solely based on the diagnosis from a single doctor. If a doctor has provided your care for sometime he/she can usually make the right recommendations for you. But when in doubt ALWAYS get a second opinion!

To answer a few of your questions:

As to risk – I believe the same low risk factor applies to the replacement as it did to your initial implant.

Recovery period – It will most likely be the same length and include the same restrictions as you first surgery. (Mine always have)

Lead left in or taken out – Since your lead has been in place since April I would think that it would be better left in place, but I’m not a doctor. (I have a migrated atrial lead that was left in place.) I believe it would depend on how imbedded the tip is with scar tissue.

Where will the new wire be – Again I’m not a doctor but speaking from my experience the new lead would run along the same path as the old lead. But I would think that in your case the placement would be slightly different so not to repeat the old wear pattern on the new lead.

A lead replacement is pretty much the same procedure as it was when you first received your pacemaker. (Except this time you know what to expect – big difference)

They will take your pacemaker out and replace and/or reposition the lead then put the pacer back so it is pretty much the same as the initial install job.

Don’t be afraid to ask your doctor all of these same questions. He/she should have no problem thoroughly explaining everything to you in full detail.

If you have anymore questions I’d be happy to help if I can.

Live Well & God Bless


.

LEADS

by pete - 2009-01-25 02:01:46

It would seem to me they did not make a very good job of positioning the excess lead when they implanted your pacemaker. Leads are far more likely to give trouble than the pacemaker, but yours has started giving trouble in a very short space of time. They are supposed to be guaranteed for 25 years these days. Get a different EP to sort it out to be on the safe side. Cheers Peter

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