Dodgy lead - help needed

My husband has had a pacemaker since 1992 for Sick Sinus syndrome, with 2 replacements. The leads are the originals: Pacesetter St Jude. He had previously (around 5 years ago) had a dx of A fib, for which he was given beta blockers and flecanaide. It later appeared that these symptoms had been being caused by a dodgy pacemaker and he has been meds and symptom free for 2 years since the insertion of his newest pacemaker.

Last week, however he was admitted to hospital with chest pain, arm pains and shortage of breath. ECGs, blood pressure and blood tests were normal, but his pacemaker check showed a 'lead warning' and a history of intermittant resting heart rates as high as 206 beats per minute.

He's home now waiting for a heart tape, but in the meantime our questions are: does anyone know what a 'lead warning' means eg imminent replacement or 6 monthly checks etc, and also what are the symptoms of a dodgy lead.

Am very worried about him, so any info would be gratefully received. Thanks Di

5 Comments

lead warning

by Tracey_E - 2009-10-08 11:10:25

Lead warning can mean a lot of things. Some problems that cause the warning can be fixed with programming, sometimes they just watch it, sometimes it needs replaced.

I've had a lead warning for 7 or 8 years now because my lower lead has a kink and is ruptured through 2 of the 3 layers of insulation. They programmed around it so it still works but it drains batteries quickly. I kept it through my last 2 battery changes but decided to replace it next time, the doc left it up to me. Three year batteries is getting a bit old! :o)

Amen

by donb - 2009-10-09 09:10:41

Good Info Frank!!! I could have saved me alot of grief had I been a member of this group with good information like this. After my 3rd PM replacement my Cardiologist told me I now have the Cadillac of Medtronic PMs' (BUT) "I had to parallel your leads as one lead was bad" Well this was just after recovery and I should have questioned his statement. This was a clue that I needed more info. After Erosion, PM removal, New right chest installation, old site lead caps or terminals eroding again, and 2 more surgeries to clean up old site I'm back on the road again. Now, a few days ago, my Cardiologist tells me that the Medtronic PM that he had to remove was bad, wonder WHY?? You just don't mess around with bad leads. I allways wondered what he meant by the using the word parallel as this meant in my mind that he connected them together electrically where he actually meant mechanically for lead support as there was a insulation fracture in the venticular lead. This caused electrical leakage causing terrific scar tissue build up and finally erosion. So, Frank, had I had your input a few years ago I could have saved me alot of grief which again shows have valuable our members postings are. Gotta say it: Thank You Frank. DonB

Parallel leads

by ElectricFrank - 2009-10-09 10:10:16

As I was reading your comments wondered the same thing about parallel leads and then you cleared it up.

I hadn't thought about the amount of scar tissue and erosion that could happen from electrical leakage. They probably turned the voltage way up to get enough to your heart to achieve capture.

That brings up a conflict I have had with the cardiologist about voltage settings causing PVC's. I have insisted that higher pacing voltage could cause irritation of the heart wall which can make it more likely to spontaneously generate a contraction on its own.

frank

Lead warning

by ElectricFrank - 2009-10-09 12:10:30

A lead warning isn't the same as a battery life warning. As Tracey mentioned a lead warning could be flagging a number of problems. The most common could be:

A lead that has detached from the heart wall and is flopping around. This causes sensing and pacing to be erratic.

A lead that isn't attached properly to the pacemaker. The Medtronic implant instructions mention that this is a common cause of lead problems. If the lead wasn't originally seated properly in the pacemaker socket it is possible for body fluids to cause electrical current to conduct out of the socket.

The same thing happens with ruptured insulation (like Traceys) except the current can lead out where every the problem is.

It is also possible for the conductor in the lead to break which causes a complete loss of that circuit.

Since leads are also used to sense heart activity, ruptured insulation can allow signals from muscle activity or movement to give the pacer false signals. As an example if my atrial lead were compromised the pacemaker might use signals from my diaphragm muscle to pace the ventricles, which could get exciting. Take a deep breath and my HR would go sky high.

Hope this isn't too complicated.

If a lead is going bad and it is causing problems the only fix is to replace it. I would be on the lookout for the docs trying to fix it with meds. The results will never be as good as a properly working pacer.

Hope it all works out well,

frank

Thank you

by Diane - 2009-10-11 08:10:18

Thank you so much for your replies.

Frank - hope I don't sound stupid, but could you explain a bit more about the two way communication and the diaphram bit.

My husband seems to get breathless either when he's sitting down or particularly when he leans over or bends down to get something and then stands up again. From your post I'm wondering could his PM be picking something up?

We have hospital appointrments on Thursday, and I think they will just put him back on beta blockers unless I know what specific questions to ask/what checks need to be done.

Thanks again for your help - what on earth did we do without the net?!

Di

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