Heebie jeebies

Hi there, fellow bionics, can I share some concerns? In addition to reasonable heebie-jeebies at starting my new battery-operated life, I find myself with serious doubts about getting the straight scoop from my cardiologist... and even more serious doubts about the performance of my new Boston Scientific pacemaker with Guidant and Medtronic leads.
A month ago, during the PM implant procedure, I woke from up in the cath lab to hear the surgeon complaining he had lost the lead. So thumps and scuffling later, the two hour procedure ended. That night my atrial lead dislodged and the following day I was forced to have another two hours in the cath lab, this time fully unconscious. The reason for the difficulty, according to the surgeon, was the unusual smooth wall structure of my atrium. My concern is that four hours of trolling around with a lead on a hook looking for anchorage in the wall of my heart probably caused some scarring. My cardio says no problem... I'm just not sure.
Checking out the PM things seem OK and I feel good but the atrial lead was found to have an "elevated capture threshold" possibly due to increased resistance from scar tissue. It's no problem says the cardio because I have a two lead system and don't really need the atrial lead right now. I have a complete AV block and the top and bottom chambers are not happily talking to each other and getting along nicely.
Anybody out there with similar experience...smooth heart chamber muscle...difficult lead implantation ... elevated capture threshhold...freaking out over nothing??? Some advice or just plain commiseration would be much appreciated.. Thanks

Banjolt

5 Comments

trust

by Tracey_E - 2009-02-16 01:02:23

There are others here who have had problems getting the leads anchored. It's not common but it's not unheard of either. Sometimes using another type of lead helps, like the screw instead of the barb type. I've never heard of this causing damage or scar tissue- if they can't get it in enough to anchor the lead, they can't likely can't cause lasting damage either.

You need to feel comfortable with and and have faith in your doctor. If you feel your doctor is giving you the run around, it's time to get another opinion.

Technically you don't need the atrial lead with an AV block, but it's nice to have because it means better communication. I have an AV block also but still use my atrial lead 4% of the time. Not huge, but it is used.

I'm sorry you're off to a rough start! Know that once they get you situated, you'll more than likely feel terrific until it's time for a battery change. Those of us with av block are fortunate that our problems are relatively easily fixed.

"It" happens

by BillMFl - 2009-02-16 01:02:44

My first pm install back in 02, one of the leads punctured my lung which was lots of fun when I got back to my hospital room and couldn't breath well. Murphy's law applies to cardiac procedures too! :)

Don't Sweat Your PM

by SMITTY - 2009-02-16 01:02:50

Hello Banjolt,

Welcome to both clubs. The Pacemaker Club and the club where pacemaker recipients have less than full confidence in what their doctors are telling them. I suspect the latter of the two clubs has the most members.

I'm of the opinion there are two main reasons for the doctors not always telling us the complete story, or truth if you prefer. One is they probably think the patient wouldn't understand and the other is the doctor doesn't really know. You can decide which of the two ranks first.

As for concerns, I say don't worry yourself about what may or may not be right now. If your pacemaker is solving the problem for which it was implanted then nothing needs to be done regardless of the problems encounted during its implanting. If it or a lead fails later, you will be no worse off having the corrective procedure made at a later date than you would if it were done now. Actually a later date could be in your best interest as your doctor may have more experience and knowledge later.

Of course some will probably want to argue about my statement about later being as good as now when it comes to leads. From what I have been told about my leads, which have been in place since 2000, that after about 3 or 4 years a lead can be imbedded in tissue to the point that they may difficult to remove. However, with the improvement in the tools a doctors has today versus what was available a few years ago, even the very tough ones to remove can now be reactively easy. So again, time is not as critical as it once was.

The best advice I can offer is don't sweat your pacemaker. It will sit there sending impulses to make your heart beat as necessary with out outside input. You will have PM checkups often enough that any needed changes can be made as your heart's needs change, so there is really nothing for you to do when it comes to your pacemaker. The only thing I seriously try to avoid is a direct lick on my PM. Not that I think it will harm the PM, but because the leads coming off the top of it, even after 8+ years, are fragile and a lick on the PM will hurt. Other than that I never think of mine unless someone asks about it, or I read something here that makes me think of it.

Good luck,

Smitty

comisery granted!

by Megherbst - 2009-02-16 02:02:06

When I had my pm implanted I reacted badly to the drug they tried to use to sedate me. Istead of sedating me it made agitated and angry. So basically I was aware and awake during the whole procedure while cussing at the doctors and them telling me to stay still. And to add insult to injury when they first started the procedure they didn't get me numbed enough so I felt them cut right into me. My specialist in Toledo told me that should have never happened. If I hadn't of needed a pacemaker so quickly I was going to have the specialist in toledo do it. Anyhoo, at least I know it won't happen again my specialist said when I need a replacement I can be put under general so I completley unconcious. Thank god! I'm so sorry you had a bad experience I can really understand it stinks really bad and I don't trust my local cardiologist either.

Right there with you on the freaking out

by furnhusch - 2009-02-16 12:02:30

I got my pacer on Feb. 10th and I also heard the doctors discussing their difficulty threading the leads because of a vein branching where they did not expect it to. So as to not repeat myself, see my previous post and response on the Complications forum.
I think I can commiserate with you adequately. I don't think excessive worrying or freaking out will help either of our situations, but that's easier said than done. But just remember that you're not alone in having bouts of uncertainty and mild terror.

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