Clavicle First Rib (CFR) Entrapment

Has anyone every been told they have a CFR entrapment? My leads and pacemaker were implanted 3 months ago and my ventricular lead has developed an insulation breach that the doc tells me is from entrapment between my clavicle and first rib. I did a google search and discovered Guidant has a published Product Update warning against medial subclavian sticks - especially in lean, active people. I'm a 53-year old triathlete so I fit this category. I will need to have my lead replaced and the doctor is advising relocating the PM to a more lateral position. According to the Product Update this is exactly what he should have done in the first place. Has anyone had a similar experience, and if so, what are the risks and complications. Did you seek a second opinion or hire a lawyer?

3 Comments

surgeons

by Tracey_E - 2010-09-04 11:09:23

Just under the clavicle is the most common placement. The reasons they put it there are it's the least invasive, easiest access to the vein, fastest recovery, least chance of infection. It may have been more prudent for you to have it elsewhere but I really don't think it's negligence or malpractice when probably 95%+ of pm's are put exactly there. Even among thin and active patients, contrary to whatever that product update says it's still pretty rare to put it somewhere else. It's more common than it used to be, but most drs never even consider alternate placements for the above reasons.

Ruptured leads aren't unheard of but it's not that common either. In several years being an active member here, I can think of maybe 2 other cases like yours. Three months is awfully fast to have a problem if the problem came from rubbing when you exercise. How long did they have you wait to get back on the bike and be swimming again after surgery?

The grass isn't always greener... mine is buried deeper- about 4" lower and completely posterior to the breast, done by a plastic surgeon- and I ended up with breached insulation because the lead kinked where it was angled to get it from the vein to where the pm was buried. All fixed and I'm fine now. When it comes down to it, there's no perfect place to put it, it's still a foreign object our bodies have to deal with so any place you put it will have downsides.

Moving it is not an involved surgery, very minimal risk of complications. I don't know that I'd bother with a second opinion assuming you like and trust your dr, but I'd verify that they're using the same incision, simply making the pocket deeper rather than moving everything. Also make sure the old lead is coming out. After only three months it will come out easily so there's no reason to think they'd leave it in but it can't hurt to clarify.

Good luck!

rewired

by tedlutz3 - 2010-09-20 11:09:40

i had to be "re-wired" exactly a month after first surgery for pacemaker. doc said wire came loose. he said: "it wasn't my fault and it wasn't your fault." he asked if he wanted me to do the re-wiring. i felt comfortable with him and told him to go for it. the second surgery lasted longer than the first-- for just 1 wire (a different brand). he said that would be his second and final try. i'd have to go to someone new if the re-wiring failed. in 30 months, the new wire has stayed connected. i exercise on treadmills, stair-climbed, cross-trainer, bikes, rower, etc.
so far so good.

Update about Surgery Plans

by greg.bikes - 2010-09-21 09:09:59

Thanks to all who replied, especially TraceyE. I ended up seeking the counsel of noted specialist in my locale. He validated most of what TraceyE said in her posting regarding the initial surgery. In spite of not cycling for 4 weeks and not swimming for 7 weeks the lead still failed near the proximal end between my clavicle and first rib. He said this sometimes happens in spite of the best efforts of the surgeon. He agreed with the plan to replace the compromised lead and relocate the PM into a more protected position under the pectoral muscle - to be done after I compete in a half-ironman race in two weeks. All good news as far as I'm concerned. Getting a second opinion made me feel much better about my doctor which is something I was questioning when I made my initial posting.

You know you're wired when...

You have a new body part.

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