Tips to Avoid Revision?

I'm 33 year old gal that had my first pacemaker inserted 4/30/2012 for VasoVagal Syncope.

Its in my upper left chest area, although about 2 inches below the collarbone, just below its scar.

It's doing GREAT and I've been symptom free which is awesome.

But at my checkup last week my cardio said that if the scar tissue doesnt tighten up the pocket, that we will need to do a revision soon.


But the thing thats concerns us is that its rotating easily and alot.
If i lay on my right side, it rotates more than 90 degrees in my chest all by itself. So if im laying on my right side... its rotated so the left side is now further away from my chest and pointing towards my right.

it hasnt done a full 180 yet, but thats what he is concerned with.

also the corner that is to my top left is right on the scar line, so there no cushioning for it so the skin is not healing as well because its often brushed or bumped against.


Anyone have any ideas/advice on how to get it to move less? how to encourage scar tissue to tighten up the pocket so it rotates less?

It's working great so I'd love to avoid a 2nd surgery just to move the darn thing.

7 Comments

concern

by Hope - 2012-07-23 03:07:57

Hi! Wow! What an unsettling situation you have. Would not want the same surgeon. Whatever your decision, do watch for signs of infection until your situation is resolved. Will be thinking of you. Hopeful Heart

Operator oversight?

by Allison - 2012-07-23 04:07:55

Ask your physician if he/she sutured the device at implant. Each device has a suture hole in the header block for this purpose. Per device manufacture recommendations during acute implant, device should be sutured to assist in prevention of migration. However, there are individuals who also twiddle their devices and can break the suture. Migration is generally less with generator changes outs since the fibrotic encapsulation has already occurred.

I agree wirth Hope

by Bill T - 2012-07-23 07:07:00

Sounds like he didn't do the job right. I'v had two PM's and neither one has ever moved. I'd really consider checking with another surgeon who is experienced in implanting pacemakers.

Good Luck.

Billt

more details

by JustKrs - 2012-07-23 07:07:24

My doc is an EP at a major teaching hospital in Chicago, so he is not lacking for experience.

And he agrees that some people are "twiddlers" but he said I'm not - that this is just the pocket healing oddly.

He said this may have to do with the fact that they ended up implanting further down from the collarbone than usual... and so the bottom corners are more towards the breast tissue and therefore move around naturally as the breast tissue moves/adjusts with different movements/clothing/etc.

He said functionally its totally AOK... but if it rotates a full 180 then we would HAVE to do a pocket revision.
If it just turns some in some situations but doesnt actually flip he said it's up to me if we revise or not.

he said to probably wait a few more weeks to see if the pocket scar tissue secures it better, and to try to wear the same bra and even sleep in the bra to see if keeping everything still will help it heal better

healing

by Tracey_E - 2012-07-23 10:07:22

My first thought was simply avoid anything that makes it move to give it a chance to heal, there's not much more you can do other than hope. Then I saw you said there's a place the skin is not healing. Keep a VERY close eye on this, it is called erosion and can lead to infection. A revision is a lot easier to deal with than an infection. If it does not heal up soon, I'd go ahead and get the revision, just my opinion. It's a simple surgery, much easier than the first placement.

pm moving

by Alma Annie - 2012-07-23 12:07:53

Hi there

I had my pm 13 months ago. It did not take long for it to move. It turned 90 degrees after about 2 months. It has since moved more and the wires to the leads are almost under my arm. The way I turn over in bed on to my left side, sometimes causes the pm to flip up vertically. It then flopped back down again!
The first time this happened I said something to myself that I shouldn't have done!! When I told the technician later, he raised his eyebrows, as did the EP, but EP said it would not be damaged, they are tough. I still have to be careful with things like seat belts, when a passenger, (we drive on the left here in Australia) as they make the site feel quite sore, also with bra straps.

EP says that when he changes the battery he will put it under a muscle, but until then don't worry. The only thing that can go wrong is the feeling of soreness. Certainly he would not change it now.

Hope this helps. Let us know how you go

Alma Annie

ask your dr about this

by angelssunrise - 2012-08-10 05:08:25

I just had to have a revision about two months ago due to my device trying to go through the keloid scar tissue. My cardio had a general surgeon do the procedure this time. What they did was made an extra incession along the side where the box is they then stitched it and then the regular incesion up. What this does is gives the wall a stronger base which will keep it from twisting. They do this procdure with herniation surgeries. Since this surgery I have not had as much movement as the first time. and the dr is confident that this will keep it in place. So if you have to have this done ask then about the procdure. All it really is doing is extra stitches inside.

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