Lead off or broken

Hi guys,
I'm new in the club... I had my pacemaker implanted on 08/18/10 so I'm only 5 days with it. I try to do my best to follow the instructions, I'm pretty sure I didn't raise the hand above the shoulder, and didn't carry anything with the arm. I got my pacemaker because IST that reacts very bad to medicines (4 times this half of year in the ICCU and 2 times vantilized and anesthetized in the ICU one time for 10 days and the other for 2, everytime on different med), they haven't started the medicine so there's theoritically no chance for collapse, the pacemaker don't do a thing now because I'm on my usual 170 sinus tach.

The thing is I do still feel pain around the shoulder where the device is implanted. What I should feel if the lead is disconected?

Thank you so much and take care

8 Comments

thank you very very much

by yael1984 - 2010-08-23 04:08:47

you did help me to understand whats going on i got scared about that maybe the pain is because the leads are disconected. Not that I will try it, but why the recommendation is not to lift heavy stuff for few weeks and not to raise the arm above the shoulder? Thank you very much guys you really help me a lot here take care you all

restrictions

by Tracey_E - 2010-08-23 07:08:37

They put restrictions on the arm to give the leads time to get secure in the heart. Raising the arm can potentially put stress on the leads and pull them out.

leads

by Tracey_E - 2010-08-23 11:08:50

It takes some time for the device to settle in and the shoulder pain to go away. It's perfectly normal to feel it at this point. It would be extremely rare to come disconnected at the device. When we talk about disconnected leads we usually mean the other end, in the heart.

PM Lead Concern

by SMITTY - 2010-08-23 12:08:22

Hello Yael,

Welcome to the Pacemaker Club.

As Tracey said leads are much more likely to get separated from the heart wall than they are from the pacemaker. At the pacemaker the lead tip is placed behind a metal strip which is then tightened down with a screw. I can't imagine how anyone can get one of those things lose without losing the screw. At the heart end it is a different story and a lot depends on the skill of the surgeon as to how well they are attached to the heart wall.

After my first pacemaker I felt nothing around the PM implant site once the soreness was gone. I got its replacement last Oct. and even now I feel little twinges of discomfort as far away from the PM as the top of arm from time to time. But the PM is implanted on top of or in the pectoral muscle.

When I mentioned this to the doctor his comment was that is from some of those pectoral muscle nerves we disturbed and the discomfort will go away in time. Maybe it will, and I do have to admit it is less intense now than shortly after I got the PM.

If you have time read the information below on leads and if you want some in depth details goes to the web site shown below.

How do the leads stay in place?

Some leads are termed "active fixation" (see pictures at the beginning of this section). These have some means of being secured to the heart muscle, typically a screw device. These decrease the tendency of the lead to move early after it is placed, but are often not as efficient in sensing and pacing in the long run.

The other main variety of lead is a "passive fixation" device (see pictures at the beginning of this section). These have little extensions off from the lead which become lodged in the irregular contour of the heart muscle. These have the advantage of often providing better long term performance in sensing the electrical impulses. However, they have a slightly greater incidence of becoming dislodged early after their placement.

In either case, the leads will become firmly attached to the heart muscle over time. Early after implantation, the leads will induce a mild inflammatory reaction. During this period of time, it will take more than usual amounts of energy to capture the muscle. Generally, the leads become very fixed to the muscle after about six months, and are difficult if not impossible to remove.

http://www.heartpoint.com/pacemakers.html

Good luck,

Smitty



"bonding"

by cruz - 2010-08-24 09:08:38

The leads need time to "bond" or attach themselves and any strain to the arm could interfere with this and could potentially cause the lead to be disconnected from the heart. It's actually "growing" into the spot during the 6-8 week period. The pain in the shoulder area is normal. I had pain that made sleeping near impossible in bed at night. I was only comfortable when I had my shoulder cushioned around in my favorite chair for a couple of weeks. Slowly I kept trying to ease myself back into sleeping in the bed but couldn't sleep on either side. I felt like the device, at times, was "clunking" around when I would turn on my side or bend down to pick something up. I would always think I had inadvertently "disconnected" the leads. There would be twinges, tingling that felt like little needles in the chest and shoulder area too. After about 4 months, all the twinges and the clunking around subsided. I still occasionally feel the little needling feeling. It goes away slowly and pretty soon you don't realize exactly when it went away...just that it's no longer happening. It's hard not to stress and worry. Going in for the interrogation I would always be sure they were going to say it wasn't working. Hang in there. I don't know why they tell you that you won't even know it's there in a few days/weeks, but in reality, you know it's there. I still never forget it's there and I had this done in February.

Thank you very much for all your support

by yael1984 - 2010-08-24 09:08:56

For how long you've been telling not to raise the arm or carry heavy stuff? in addition, does carry the lap top (the big not the net book) is count as heavy stuff? sorry for the beginners questions, usually somehow the patients knows more than the doctors (I see it in the coping with the diabetes alot)

Thank you very much again and take care

I just knew...

by heckboy - 2010-08-26 08:08:38

...what was too heavy to lift. A kid, no...a laptop...maybe.

Sometimes, I would wake up and find my arm above my head and panic, but it didn't pull a lead. I did manage to pull a lead a year into my first PM, but since the lead was still partially implanted, they just turned up the power to compensate.

T-shirts are easy if you put your left arm in first.

Don't forget to tell them to tweak your settings as much as you want to find what is best for you. I was in ever other week for months on my PM until I found the best settings.

thank you very much for the information

by yael1984 - 2010-08-27 09:08:12

You did help me alot... I had the appointment in clinic and nothing move... but still it's some psychological fear, maybe because it's something very new and everything. What do you mean settings?

Thanks for everything and take care
Yael

You know you're wired when...

You can finally prove that you have a heart.

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