Complications with 3rd Lead wire

My husband's heart issue & recent diagnosis was a Bundle Branch Block, with the top two of the electrical connections of the heart not functioning properly or at all.

BTW -- we are out of insurance network, because of his emergency issue a few weeks ago -- & the fact this latest episode occurred on the weekend.

I will be happy to supply further info as needed.

My husband had emergency surgery & placement of a St. Jude’s Medical Pacemaker about 10 days ago. We were & continue to be very hopeful that this will solve the health issues & general malaise which he has experienced for some time, esp the dizziness, fainting, & feelings of both.

The day of the surgery, we were told by the surgeon that my husband’s surgery was successful. Yet minutes before our dismissal from the hospital on the day after surgery, we were told by the surgeon – that there was, indeed, a problem. Two wires were working ok (whatever that means), but the third which was supposed to be registering between 3-9 was actually registering between 1.2 & 1.9 (average of 1.8, they said).

BUT NOT TO WORRY, they both said. The wire could place itself correctly, even if the MD & technician did not do this initially. They recommended we go home & wait & see what happened to the wires during his first post op appointment in 3-7 days – the one to remove the bandages after surgery – the one they couldn’t schedule until the 10th day at the MD office. That day is tomorrow. They would decide then IF they needed to operate once again to correct this first error.

Does anyone out there have any experience with this third lead wire being located wrongly during surgery or of it slipping out of place? Also, what might your experience with this problem suggest that we do.

The MD did tell us that he noticed (!) that that 3rd wire was not in the correct place before he was finished with the surgery, but that he made the decision not to correct its placement at that time & also not to tell us about it at that time. He did not consult me for a decision about the 3rd wire.

The MD & the assisting technician both offered my husband the choice of correcting the third wire placement in a 2nd Pacemaker surgery that same day before going home from the 1st surgery OR of going home that day as originally scheduled & HOPING the wire correctly placed itself within acceptable number range. Does this wire magically correct itself & its placement in the heart??

HELP!! Does anyone know anything about lead wire placement?

What function does each wire serve?? If the correct reading on the 3rd lead wire is no big deal (as MD & technician both said) why did they place it in my husband’s heart in the first place??

Has anyone had any experience of lead wires being misplaced in the heart so as not to function properly?? What is the outcome of this problem for my husband & his heart issues??

Has anyone had a 2nd surgery to relocate one of the lead wires properly (specifically the 3rd or bottom wire)?? Again, can/will you share your experience with us??

Where online can I find info on the function of each wire in the Pacermaker & the parameters OR proper beginning readings of each wire before it begins to function as it is supposed to function. I am also interested in the lead wires & what readings will cause him further & possible problems.

Thanks to all of you who might take the time to respond to my questions.



6 Comments

Response to Third Wire/Mark

by kubie - 2009-11-17 09:11:39

Thanks so much for responding, Mark. It is reassuring to hear of someone else's experience & response & suggestions to this same problem.

Kubie

Third Wire

by Mark_in_NJ - 2009-11-17 09:11:48

Kubie,
I just had my PM installed last week. It was also a three wire CRT-D. The third wire down to the left ventical is the hardest one to place since it has to be fished through the coronary sinus vein. Mine took a little longer that usual.

The voltage can be adjusted after the surgery is done. I know because mine needs to be adjusted. I'm getting a twitch in my back due to stimulation of the phrentic nerve. Like you I was worried that the third lead would need to be surgically repositioned. Probably it can be fixed with voltage adjustments. I hope this is the case for your husband also.

If repositioning is needed, I saw that there is a technique to go in through the groin like a cardiac cath. This is less intrusive than opening up the pocket and and removing the PM. A second opinion could give you peace of mind if you doubt your doc.

Sorry you both have to go through this. It is stressful enough without complications.

Best of luck,
Mark

Lead problem

by ElectricFrank - 2009-11-17 11:11:02

The reading mentioned is what is called the Lead Impedance and is a measure of how good the connection is to the heart wall. A higher reading could be due to it being located in plaque, scare tissue, or not penetrating into (not through) the heart wall enough.

The effect depends on which of the 3 leads they are talking about. If a lead is only used for sensing, the increase will likely not make much difference. If it is a pacing lead the higher impedance gets in the way of supplying adequate current to the heart wall. The work around is to program the pacing voltage higher. The downside to this is that it increases the chance of producing uncomfortable twitching in adjacent muscles and also shortens battery life.

An important thing to consider is that the lead becomes scared into the blood vessel wall with time so removal or repositioning it is more difficult and risky. As for accessing the lead through the groin, this is a more invasive procedure than going in through the pocket. It is mainly used when there are problems extracting a lead and they need access from two directions.

If it were me I would have it fixed while it is easier to do. Like you I wonder why put in a 3 lead pacer and then say it isn't all that important.

hope this helps,

frank

lead problems

by papaknight - 2009-12-22 02:12:34

For a fee, $565.00 I think, the cleveland clinic will take all of your films and record and go through them with group of their specialists and provide you with a recommendation. If you have unanswered questions or doubts, I think this is money well spent. Others may do tthis also but the cleveland clinic does hundreds of lead replacements yearly. Best of luck to you and yours
PapaKnight

Looking for online MD eval

by kubie - 2010-01-05 06:01:12

Where can I get FREE info & eval of all local MDs, incl cardiologists, surgeons, etc??

Is 2nd Surgery nec to correct lead wire prob?

by kubie - 2010-01-05 06:01:17

My husband had emergency Surgery on Nov. 8th, 2009 when his PM was first implanted. We were "out of network" for the surgery, as this was determined to be an emergency. He is 66 yrs old & generally in good health. He had suffered from syncope & dizziness for several months & had a gazillion heart tests prior to his PM implant.

Anyway, DH had a Right Branch Bundle Block. His PM has two lead wires, if I understood both MD & PM Technician correctly. One is called an arterial lead & the other a ventricle lead. The arterial lead appears to be ok & properly placed.

The ventricle lead wire was not properly placed to begin with. The reading on this lead wire was supposed to be from 3 to 8. DH was told his reading immediately after surgery was 1.2 - 1.9. This was still within acceptable range, he was told by both the surgeon & technician.

By the time we left the hospital, it was reading 1.5. It was reading 1.2 when DH had his 1st appointment with the cardiologist & technician three weeks after the surgery. It was reading only 1 when DH had his one month appointment (which actually was almost two months after the surgery).

The surgeon told us he made a professional decision NOT to correct his error (my words, not his) at the time of the original surgery. He did not inform us of a problem at that time & let us make our own decisions, btw. I would have been inclined to fix the problem immediately or as close to immediate as possible, had I been asked for a decision while DH was "still under."

DH has a St. Jude PM with Medtronic lead wires. Is Medtronic still having trouble with its lead wires?? If so, why would the surgeon choose these over St. Jude lead wires for the St. Jude device??

IS this typical for the Medtronic lead wires?? Is this 2nd surgery necessary? Should the 1st surgeon correct his problem?? Should we go to University Hospital (DH's insurance network) & have the 2nd surgeon correct the problem of the1st surgeon??

Are we being bounced around -- because of the insurance network issue?? Prior to surgery, we raised these questions, but could not get anyone to talk to us about this insurance network issue -- DH's primary care MD was conveniently "out of town", his insurance network cardiologist only works on weekdays (this was a weekend), etc, & didn't return our request for a "personal consultation call" before we decided to do the PM with the local cardiologist who is "out of network".

The surgeon is very pleasant & always full of smiles & "don't worry" about the ins network comments. However, I am convinced this original surgeon is stonewalling us, as he gives a 90 day guarantee on his work (weird for a medical procedure, I think). He appears to be trying to get us past the 90 day mark before he makes a decision to correct HIS original error. Then the PM fix will have to be done at another location by another surgeon. Convenient that then both surgeons will actually collect $$$ from the insurance company!!!

Should we contact Cleveland Clinic for advice?? Should we trust DH's original surgeon?? (already I have major doubts about his qualifications AND his integrity re the original surgery & the repair which should have been done immediately, I believe -- which I mentioned before DH was dismissed from the hospital.)

Please share your personal experiences & knowledge on “corrective surgery” for improperly placed lead wires so soon after the original PM implant.

What exactly are the heart & PM problems DH will face with a poorly wired PM should the original (& network” MD, too) MD determine not to do a 2nd surgery (which he has been inclined to do so far).

Thanks for any help & words of wisdom from all of you out there.

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Sometimes a device must be tuned a few times before it is right. My cardiologist said it is like fine tuning a car.