Can you live with a fractured lead?

Hi All,
Had PM replacement on Thursday, all went well and was told in theatre my leads were ok.
On post op pacemaker check, they found abnormal readings.
Consultant came back and checked, told me that atrial lead is fractured and making a noise the pacemaker doesn't like.
I have been sent home with a 48 hour monitor on and then they will make some decisions.
I am so fed up it wasn't found in theatre.
So does anyone know, will I have to go back in immediately now to have the lead sorted?
Thanks guys

15 Comments

Fractured lead

by golden_snitch - 2014-10-18 05:10:58

Sorry to hear this, jue! :-(

If you need to have the lead replaced immediatly depends a bit on your condition. If you have sinus bradycardia/sinus arrest, and the atrial lead doesn't work, you need to have it replaced as soon as possible. If you, however, are a heart block only patient, you might do just fine with a functioning ventricular lead only. Generally speaking, it is better for heart block patients to have a dual-chamber device, just in case you atria ever need support or in case the timing between atrial and ventricular contractions is not good. But there were times when heart block patients received mostly single-chamber devices, and there are still doctors who implant them for this condition. So, if you are a heart block patient without any sinus node issues, and you are fed up with surgeries for now, you could always discuss this with your surgeon and ask for lead replacement to be hold off for a while.

Best wishes

Inga

Thanks zings

by jue - 2014-10-18 06:10:00

Thank you Inga, I am a heart block patient and my consultant did say, if it was the other lead it would be more serious.
Just puzzled really as to why they said my leads were fine in theatre and then straight after the op, said one lead was fractured!

leads

by Tracey_E - 2014-10-18 07:10:16

I would want some answers also as to why they didn't catch it when during surgery! Heck of a coincidence.

As Inga said, if you don't use it you may be able to turn it off rather than deal with it right away. I also have heart block, my ventricular lead went bad. It still paced, but they had to turn up the juice to get the signal through. It worked but the battery didn't last very long (picture the window open with the air conditioner running. the house cools but the power bill is high) I lived with it that way for several years until the battery died, then had both replaced at the same time. Other times when the lead goes it isn't working at all so needs to be dealt with quickly.

I will want answers!

by jue - 2014-10-18 08:10:10

Thanks Tracey E,
Yes you are quite right I do want answers as to why they did not pick it up in surgery.
Also my replacement was booked in as an emergency as my battery had totally gone, so seeing as though my leads could not be tested on Tuesday at my appointment because my battery had gone, I fully expected a chest x ray before the op to check my leads.
Just feeling very angry and let down at the minute, oh and still very sore !

Emergency

by golden_snitch - 2014-10-18 09:10:45

The emergency surgery would be no reason to underdiagnose a broken lead. Even with the battery depleted, they could have looked into the stored data and the impedance curve would have probably shown that you had a fractured lead (impedance goes up in a fractured lead, down in one with insulation damage). A fracture usually does not happen all of a sudden. I had a fractured atrial lead back in 2010, and the impedance curve was indicating this over weeks and months, slowly getting worse and showing more and more impedance peaks, before we decided to replace it.

Also, as soon as you connect old leads to a new device, you check them or rather the device checks them automatically. No idea what your surgeon did, but if I were you, like Tracey, I'd want answers, too.

Inga

Grab an oar & start paddling...

by donr - 2014-10-18 10:10:30

...we are in the same boat! A lifetime ago in 2007, I had a lead fracture - a Medtronic lead, just like you. Probably not the same model, but same manufacturer.

At least mine was not an emergency replacement issue because of a dead battery, but nonetheless, it was big time annoying. I went through much of the angst you are experiencing, so I can give you first person commentary.

1) Vent to us, not your surgeon. We can only guess what went astray, not speak w/ certainty.

2) My experience was (& is - & I suspect that Inga will agree) that the best approach to getting answers as to what went wrong is to ask, as opposed to demand. A friendly, but insistent discussion approach - at least to start - usually gets more real, satisfying answers, as opposed to defensive ones. This depends on the personality of the surgeon, of course. If you have one with an ego as big as a Rolls Royce, you'll get nothing, no matter what you do.

3) Since your battery failed, they may not have been able to retrieve from the PM's memory what had happened to the lead prior to the replacement - but here I have to guess - was the battery totally dead, such that it had zero energy left in it? Usually when a battery fails, it just no longer can provide any USEFUL energy, but it has some left that can be tapped to perform low energy tasks, such as retrieve data, but NOT perform any pacing effort. Also, PM batteries do not just suddenly, precipitously quit - unless there is a sudden energy drain - like a short circuit in a failed lead. That's why there are two periods of warning prior to a battery needing replacement. AND why the two periods are so long - 3 months under normal circumstances. I just read your "Last Appt" comment - so your battery was not TOTALLY dead - you were on reserve, so the PM should have told them what was going on w/ the lead IF it was already totally bad/fractured. Ask about that data - they should still have the PM download data. From the sounds of what you have written, it appears that the lead was already in trouble.

4) Was there any reason why the surgeon should have suspected that the leads had failed prior to surgery? Was that idea even discussed w/ you prior to the replacement? You mentioned lack of an X-ray prior to the replacement. I had several X-rays in the search for what was going wrong w/ my PM when the lead fractured. MOF - I had two that were searching for a lead problem & neither one showed anything. The third, by another Dr. for another reason, showed clearly that the lead had broken completely & there was a gap between the two ends of the lead.

5) Usually they check the leads w/ their PM computer prior to sewing you up. Often an X-Ray is taken then just to confirm that all is well inside you where they cannot see - just to preclude this sort of thing. This is a question for you to ask about.

6) It is completely possible that all this was performed & all checked out well. The failure could well have occurred AFTER you were closed up. This actually sounds like the situation. You stated that they told you while you were in the theatre that all was well. This tells me that you were conscious & rational & capable of communication. Why should the surgeon lie to you about that?

7) Do you know WHERE the lead failure is? Inside the vein? Inside the heart? between the vein & the PM case? This makes a lot of difference. From the vein entry point on to the implant site in your heart, nothing was done to the lead. Only between the PM case & the vein entry point. With an old lead the manipulation of the lead during the exchange of PM boxes could well have stressed an already failing lead, leading to a failure shortly after being sewn up. You mentioned post-op checks - how long AFTER the operation were they made? Minutes? Hours? Next day? You did not mention that. Did you spend the night after surgery in the hospital?

8) Here's where we are paddling the same boat - You have a situation where you are not really using the Atrial lead due to heart block, as opposed to Atrial problems, like Bradycardia. When my Atrial lead fractured, I was not using it very often. This was 4 yrs post implant. I'll admit it - I did not really understand all that was happening to me.

I do clearly recall the EP who performed my lead replacement asking me if I wanted to just wait & see what happened in the future & put off the lead replacement till something happened to require it - after all, there was no indication that I needed the lead at that moment. I replied that I wanted it done then - I could not predict the future. So we did it then. Sometime after that, I started using the new lead more - I've been using it 99% of the time for years, now.

Given the opportunity, have them replace the lead NOW. You cannot predict the future, any better than I could. OK, so you are angry & agitated. If you elect to put it off, your mental state will not improve & you will be carrying anger & stress into the very uncertain future of perhaps needing that failed lead on an emergency basis at a time that is really inconvenient. Why have to face TWO recoveries from surgery, when having it done now means only one recovery period?

9) Do you want a solution to your problem or revenge on a surgeon who may have wronged you? Answers about the past do not solve your problem. You want answers about the future & what can/should be done. You want to be a part of the decision making for your future.

I hope you find them.

Donr

another opinion

by Tracey_E - 2014-10-18 10:10:31

A chest xray probably won't show if a lead is impeded but it would definitely show up when they interrogate the pm. I can't imagine the old one so low on juice that they couldn't test it. As Inga said, when they connect the new device, one of the first things they do is check it out which includes testing the leads.Something isn't adding up here, they had multiple chances to test those leads. I would want another opinion.

How long had it been since your last check? Were you expecting the battery to go or was it a surprise?

Last appointment

by jue - 2014-10-18 10:10:54

Hi All,
My last check up was in July, they estimated 8 months left on battery, so booked me in on a three month appointment.
When I went back on Tuesday they said my battery had totally gone and that I was using the reserve and they needed to book me in straight away.

Thanks for input

by jue - 2014-10-18 11:10:27

Donr,
Thanks so much for your input.
Post op checks were done about an hour after coming out.
All I want is the problem resolved ASAP, I do not want to wait and see what happens, I want to be able to carry on with my life as normal without worrying.
So yes, I do want some answers from my consultant as to what happened, but more importantly I just want the problem sorted.
Will keep you all updated next week when I know more.
Thanks
Julie x

Lead Problem

by donb - 2014-10-18 12:10:24

Hi Julie, Glad to read DonR's posting with your lead problem as he covered & described it well. There's been a number of members who have had leads problems with attachment to their heart wall. One member had 4 surgeries to relocate attachment in the 1st month.
I have had a number of lead work done as I'm now on my 6th pacemaker with the 3rd pair of leads. Infection also contributed to lead problems. When my 4th implant started to erode blood work & culture tests showed negative. Then my 5th implant would not sense my HR & keep me at 60 which I noted to attendants while in recovery. 30 days later Medtronic Tech did my interrogation & was told pacemaker is working "fine".
A few months later #5 needed serious help as I went to our top University Hospital & found infection of my site along with lead infection with no atrial sensing. TEE test showed
"Vegetation" growth inside my heart also, hence no atrial sensing. So after IV treatment, both my left & right chest sites are no longer used as I'm housing my #6 pacemaker in my right lower belly & finally all is well!!
I want to mention I'm way too active & have worried needless of lead fracture in the 22 years only to find attachment of leads to our heart wall is all too common.
Also, Tech Reps, some are marginal in doing interrogation as I tried very hard & got nowhere which really upsets me having spent all my life diagnosing electronic equipment & maintenance. Sorry, this was lengthy !!
DonB (The other Don)

I feel ok

by jue - 2014-10-20 01:10:34

Thanks TraceyE,
I feel fine, apart from the pacemaker site is still tender , sore and feels like the pacemaker is right on the surface of the skin, I know I need to give it time to settle down.
Other than that I feel ok, but am panicking as I have been told a lead is fractured.
My Dr secretary has phoned this afternoon to re assure me I have nothing to worry about, the 48 hour tape will be reviewed on Thursday, then they will let me know what needs doing, just feel like I am left in limbo😢

Help

by jue - 2014-10-20 05:10:55

So guys the saga continues,
My 48 hour monitor has been returned this morning.
I spoke to my Dr secretary who said she does not think the Dr will get to look at it until the end of the week.
I told her I had just had a replacement and afterwards a fractured lead was found, she just said don't worry.
I really thought that my tape would have been looked at urgently, this obviously doesn't seem to be a big deal to them.
Am I ok, going about my normal life with a fractured atrial lead?
I also told the secretary I need to know what's happening, as I should be travelling to Vegas in five weeks and need to know if I have to cancel, she said I don't think it will come to that.
I am totally confused, can anyone help........ Is this an emergency situation or is my Dr likely to take a lets wait & see approach?

how do you feel?

by Tracey_E - 2014-10-20 12:10:49

If you feel ok, then the leads are working well enough to keep you going and it's not urgent. You pace with the other lead so even if it needs replaced, it's likely not a rush.

leads

by Tracey_E - 2014-10-21 08:10:29

I had an impeded lead for 5 years before I got it fixed. It freaked me out at first because it was my ventricular lead, the one I use every beat, every day. It was stable, it was pacing, so I went on about my life and got to the point I didn't worry about it. If they tell you it's stable, it's fine! Esp since it's the atrial lead, you're not at risk if it fails.

Worried my leads will die

by garydiamond - 2015-10-23 06:10:30

I'm in a catch 22 here, my pacemaker was pushed out of its pocket, when surgical tape was ripped off it. It hurt so bad I passed out. Done to me at 5:30 am and My good arm was held to the bed. I did scream stop your hurting me, but they didn't care I was getting pay back most likely because my guess is one of them broke my glasses in the OR. And I bitched about it. My problem is I worry about the leads but the hospital that did my total shoulder replacement has denied they did any harm to me, My pacemaker site hurt like a new pacemaker put in for about 8 days. I'm Looking to get more monitoring so I won't die in my sleep from a very low pulse of 32 a year ago at rest. Two residents did this to me, I never heard them or saw them, had a eye mask and headphones on, I don't know how to convince my doctor the wires can die, I'm a retired electronic tech. who does understand what's going on, plus my stay had many more errors, but those I could over look, if I don't die first, and if my surgery comes out OK, that's still a work in progress, I got my med records which are total chicken scratch, I can't read them, and no nurse I know can, and was told by patient relations they don't have to turn them into a readable form of English, I assume they don't want me to read them, so they must be hiding some stuff they fear I will cause problems with. Now I have 24/7 stress over it, I have to see a shrink, but I'm innocent, I feel like I'm in a living hell, I now have a very short fuse. I asked to meet my attackers without any luck, found out my surgeon send them, why two men to take off a bandage, they have stuff to release the glue. I day dream of using a hot glue gun with tape, and attach it to their testicles, and rip it off

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