Lead extraction, location

I've been lurking around the forum for years and have found so much comfort realizing that I'm not the only one going through some of this stuff!

After some dizzy spells and heart palpitations, I had my four an a half year old pacemaker interrogated only to find out that my 10 year old ventricular lead was failing. Seeing as how I pace 100% of the time in my ventricle, this is apparently a problem. I was told there are two options in this situation, to leave the old in, or to have it extracted.

I've read some people's stories about lead extraction and I am starting to feel more comfortable with the idea. However, my concern is how experienced my facility is with the procedure. Does anyone know where I might find this information. My other concern is, if I feel more comfortable going outside of the state I live in to have the surgery...what are the odds it will be covered by insurance?

Thank you for all of the help and comfort you have brought me through the years!
briana

6 Comments

Decision

by ElectricFrank - 2012-02-18 02:02:08

You may not need to have the old lead removed. It depends on the size and condition of your veins to hold a second lead. If it were me I would opt for leaving it in unless there are strong indications against it.

As far as insurance coverage it can vary greatly depending on the company and type of insurance you have.

Hopefully some of the others on the forum who have had experience with lead replacements will jump in here with more information.

good luck,

frank

Hi

by Gellia3 - 2012-02-18 08:02:29

I'm with Frank. I had the exact thing happen with my 7 y/o single chamber ventricle lead back in 1982. It stopped sensing due to an overgrowth of scar tissue.

We opt to leave the old wire in and I got a new one along with an atrial wire and the first dual chamber pacemaker prototype in 1982.
I still have all three wires in there now. The first ventricle wire has been in there for 37 years and is completely inactive. It hasn't bothered me a bit and I don't regret my decision to leave it.

Lead removal has gotten alot better since I had to make the decision, but I'm still happy with the one I made.

GOOD LUCK.
My very best to you,
Gellia

A Third Option on Leads

by donr - 2012-02-18 09:02:53

Briana: There are actually three options: 1) Just add a third lead in the current vein. 2) Move the PM to the other side, abandon the original leads & install leads on right vein. 3) Extract bad lead & add new in current vein.

First of all, I'm ASSUMING you have 2 leads currently - you didn't specify. That's my situation.

I lost a lead after about 4 yrs - complete fracture w/ about a 4 inch gap between the ends. My EP & I discussed it before a surgery to add a third lead. IF he found inadequate space in current vein, he wanted my approval to move PM to right side & use that vein system. I agreed.

My EP was NOT too keen on the idea of extraction (2007). We also discussed this as an option before the surgery. He said HE DID NOT do them because it was a complicated procedure using a laser "Roto-Rooter," & he did not do them because he was not comfortable w/ the procedure. Several months ago, I sent Pookie a series of questions to ask any surgeon prior to allowing him/her to do an extraction. I'll copy them below for you.

Your profile lists you as living near Charleston, SC - that is not exactly a backwater of medical competence - there may well be an appropriate EP there who could do the job. If not, you are w/i driving range of Atlanta & Emory University Medical center. They have a potential candidate for the job here. He is my EP! If you decide to explore this option, Private Message me & I'll give you his name. We have 5 major hosp's here that do complex heart procedures; surely there is one that has a surgeon acceptable to you.

This is a COPY & PASTE of MY open comment to Pookie on this subject. Her Originating Post was on 10 Jan 2012 & titled: "Lead Replacement Question."

BEGINNING OF QUOTE (BTW: Some very minor editing to have it make more sense to you.)

WHAT IS EXPERIENCED?
Comment posted by donr on 2012-01-10 17:38.
Patch is right - you don't want some surgeon fellow doing this. (FELLOW - a surgeon in training in the specialty)

Find someone who does it all the time - at least 100 SUCCESSFUL removals per year. Oh, yes, macabre as it sounds, ask about his/her mortality rate. Any surgeon worth his/her salt will openly discuss this with you. (BTW: this is pretty much the same criteria used for finding a surgeon to do a radical prostatectomy, another extremely complicated & delicate procedure.)

Briana, remember that your life is going to be in this person's hands & you will be totally unconscious, having absolutely zero control over your fate. You want to interview them just as you would if you were hiring them to work for you - WELL, you are, aren't you. Some questions to ask:

1) how long have you been doing this procedure?
2) how many total have you done?
3) how many do you do per yr?
4) Do you LIKE doing this procedure?
5) Do you do it in a professional environment where there are other surgeons doing it, but you are more comfortable doing it than they are?
6) Are you the predominant surgeon performing this procedure here? (Wherever "Here" is)
6) Tell me what your success rate is.
7) Lets be morbid - what's your mortality rate?
8) What is/are the most common complications of this surgery? Characterize them as minor or serious (life threatening)
9) Supposing you get halfway down the vein, successfully removing the lead - is there a way to terminate the procedure at this point if something goes south - other than the procedure, itself? What about if the problem is in the procedure you are performing?

Do NOT be shy about this. You have to be a truly "Pushy Broad," & take no waffling. I think I'm preaching to the choir here.

These are the kinds of questions my Cardio's head nurse says to ask.. Their practice is associated w/an EP who does this at a major university med school hosp. He is the predominant surgeon performing it; he thoroughly enjoys it; other EP's prefer to let him do them; he does well over 100 every year. Etc. etc., etc.

I interviewed in 1973 an orthopod who had to do a rather rare procedure on our #1Son - stop his left leg from growing longer. The first question I asked him was "Have you ever done this before?" You'd-a-thunk I kicked him in the belly - but he answered "No." My next question was "Well, how do you know you can successfully do the job?" Another kick in the belly. Half hour later, after he'd finished convincing me that he could do it, I shook his hand & told him "You've got the job." Seems that it is a very straightforward procedure, but so rare that it is only done in children's orthopaedic hospitals. Most orthopods never even SEE it performed - they just read about it in books. At this point, he dragged out a moldy old text book & we wallowed around in it talking about the job to be done. And - it was a smashing success.

You need to find someone like our orthopod - who is willing to be vetted & willing to talk about the job openly, comfortably & openly - warts & all.

END OF QUOTE

How do you check them out? The Web has info on a lot of surgeons w/ patient ratings. It also has a lot of info on what their specialties are, so get any name from a med center or just a Google search for a given city & you should be able to winnow the list of candidates quickly for an interview/consultation.

Go get 'em, Briana.

And the very best of successes to you

Don

Extraction

by shockbox340 - 2012-02-18 12:02:56

Brianna,

At your age, I would suggest having the lead removed. You are likely to have more leads fail over the coming years, and things just get more complicated with more hardware. Extraction has come a long way in the past few years, but you still want to choose a high volume extracter. I'm pretty sure the highest volume extractors in South Carolina (your location according to your profile) is MUSC in Charleston, but I don't know which phyiscian is their extraction 'guru'.

Call your insurance company and ask about your options for going out of state. The answers will vary from policy to policy. Duke or Emory would be my two suggestions that are fairly close. Best of luck!

Extraction

by brirose - 2012-02-19 10:02:12

I love this forum! Thank you so much everyone for all of the input. I have to admit, before approaching the forum I was hesitant to have the extraction done. Then I read other people's posts about extractions and got a bit more comfortable with it. THEN, after reading the initial comments on here I was starting to agree, maybe I shouldn't opt for the extraction.

When I had my appointment on Friday, it was somewhat of an emergency and I was unable to meet with a doctor, so i really appreciate all of you answering the questions I wasn't able to ask a doctor.

Shock box-you being up a really good point. One of my hesitations to leaving the lead was that I am only 28, and I worry about having future leads fail and running out of real estate for needed leads. Has anyone come across this problem?

Does anyone have any information about what to expect in regards to recovery from the extraction vs. new leads? Also, does anyone know...since they will be operating on the pm, will they go ahead and give me a new generator at the same time? Since I'm due for one in about a year anyway.

Thank you again everyone! Donr...your interview questions for the surgeon are sooooo very helpful.

Briana

Extraction recovery

by shockbox340 - 2012-02-19 11:02:54

Briana,

Recovery from an uneventful lead extraction is the same as just putting in a new lead and leaving the old one. They will normally keep you overnight and send you home the next day. Short term restrictions on using the arm on whichever side your pacemaker is placed, heavy lifting,etc. The same as your first implant.

If you are a year away from ERI on your battery, they should go ahead and replace the can as well. Be sure and ask for this if you are that close. Don't give the doc a chance to make more money off of you next year!

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