Surgery very soon

I'm amazed to read about others so much like myself! This gives me hope as I am scheduled to get a PM on 4/08/15, MRI compatible with rate responsive settings. After 3 ablations for SVT, I developed sick sinus syndrome and can't get my 45 year old butt up a flight of steps without losing my breath. I have nothing else wrong with my heart but work in physical therapy and can barely manage treating my own patients.

I passed out and was hospitalized with bradycardia dropping my HR in the 30's. Unfortunately, I had a horrific experience and ended up hopping off the table and walking out of the operating room just before my surgery started. My former cardiologist had changed the type of pacemaker, chambers and surgical technique with little discussion. I never saw a rep and didn't meet the surgeon until I was on his operating table. This was at Cleveland Clinic, one of the best rated hospitals in the United States for heart related anything.

Now University Hospitals Ahuja will be taking care of me but I am still a little worried. So far I have three questions.
1) What should I plan for pain control and avoiding a hematoma? I was warned these are more common issues with sub-pectoral placement.

2) What should I be asking about PM settings? My new doc says single lead is most likely for me but he wants to test firsthand to see if a dual chamber is needed. I've been reading about resting rates, thresholds,etc.

3) Did anyone else have a hard time finding a doc that does sub-pectoral placement? Being a younger active female with a physically demanding occupation, this is important but I really had to push hard for it.
I thank you in advance for your time,
Kimberly

9 Comments

placement

by Tracey_E - 2015-04-04 08:04:37

I'm so sorry you had a bad experience, and shocked that it was at CC! I had something similar with my first one. I flatout refused any meds or to sign anything until I'd met the rep, seen my device and talked to the surgeon. They were a little annoyed with me but oh well! I know they were busy that day and fitting me in as an emergency but I can be pretty stubborn. Good for you!

I would be hesitant to get a single lead. It may well be that that's all you need and less is best, but the second lead provides information. Also, you never know when you'll need the second one. I went into it expecting to only need one but it turns out I have a secondary minor problem so sometimes the other lead kicks in. That "sometimes" is when I exercise, so it's a tiny percentage but it's important because working out would be hard without it. I would rather have the second lead and not need it than end up needing it and either doing without or having a second surgery, but that's just me.

First thing to ask about settings is what is the MAX RATE of the one you are getting. One of the mri-compatible devices only goes to 150. The others all go to 180, one goes to 220 (that one is not mri-safe). If you are active, you will probably need more than 150.

As for the other settings, just make sure they know you are active. They change the settings after the first few weeks once scar tissue has secured the leads better and your heart has had a chance to get used to pacing so what they send you home with is not intended to be forever. Rate response can take a few tries to get tweaked just right. Know that that is normal. They can make a good guess at it, but really, you'll have to try it out to see if it's going to be good for you. No two of us are alike.

My surgeon was hesitant to do subpec but understood why it was a good choice for me. He brought in a plastic surgeon to do that part. It took the pressure off him, and it was probably the easiest job the plastic did all day. EP's know hearts and their job is to get the leads in the right place, plastics know how to make it look and feel good. I expected (and was more than willing) to pay her fee out of pocket, but insurance covered it. If your doc is hesitant, ask about bringing in someone else.

I was never worried about hematoma. I've had 4 replacements now, it's never been an issue. Most of them use glue now rather than stitches which is great because not only does it heal beautifully, but you can get it wet right away. As in take a shower, that first post op shower feels soooo good!

We all differ with pain. Subpec is definitely more painful than subcutaneous. After the first 24 hours, I only took the prescription stuff at night, advil and tylenol got me through the day. I know some have reported back that they are on something stronger for a week or more but for me it was not that bad. It did, however, take longer until it was fully healed, about 3 months. That doesn't mean it hurt for 3 months, just that it took that long until I could sleep in any position, do anything at the gym, bend/twist/stretch any direction without feeling a twinge. Now, I don't even know it's there and imo it's totally worth it. I can hike with a heavy pack and it never gets in the way when I work out.

Take a button up top to the hospital. You won't want to be pulling anything over your head for a while. Also, I wore tanks with the built in shelf bra for a few weeks until I could contort enough to get a regular bra on. Try sleeping with a small pillow hugged to your chest. I found the weight of my breast would pull on the incision at night, the pillow helped with that and kept me from rolling onto my sore side.

Good luck!!! If you have more questions or just want to chat, don't be shy.

More questions

by kbell - 2015-04-04 08:04:58

Thank you all for the input! There are many things I wouldn't have thought of. I picked up the right shirts and have a list of questions for the doc. I'm definitely asking if I get privileges to ambulate to the bathroom after surgery. When I was well 147BPM was my top rate so the Revo may meet my needs. My doc said use a sling for a week but do range of motion exercises 4 times a day. An Occupational therapist I work with is designing my ex program.

I have three more questions for everyone. 1) post-surgery what nursing unit were you in? A med/surg, telemetry floor or cardiac ICU for a day? 2) were you in deep sedation for part of the testing (where they induce arrhythmias) or was light sedation enough? In the past light sedation was fine until that testing part. Thank God no ablations or 8 hour EP studies this time. 3) did you put anything on your scar for healing after the incision was closed?

beds

by Tracey_E - 2015-04-04 09:04:11

I was told to stay in bed but allowed to sit up and go to the bathroom. They did get a little cranky when I wanted to take a walk.

Great Comments By Tracy E

by Artist - 2015-04-04 09:04:18

I wish I had known about this web site before my surgery. I definitely would have been better informed about the questions to ask my doctors and would have opted for a sub pec implant. My PM is so close to my shoulder and placed so close to the surface, that is bothers me and makes me more aware of its presence and limits some of my range of movement in my left arm. Having an extensive family history of breast cancer (both sisters and grandmother) it would also have helped to know about MRI compatible devices so that diagnostic tool would have been an option. Even Tracy's comment about a button up top is great. I will go a step further. I had no idea that I would be confined to bed in the hospital for 24 hours after the procedure and told that I had to stay almost entirely flat on my back. Just so you know, that means use of the dreaded bed pan and in my case great discomfort from lying on a hard mattress and not moving much for so long. So if this might be an issue for you, consider taking a foam mattress pad along.

I told my doctors about the PM Club and hope they pass the info. along to their patients. It sounds like you will be well prepared for your procedure and after care. Keep in touch and let us know how things go. Best wishes.

more questions

by Tracey_E - 2015-04-04 09:04:25

If your top rate is 145-150, you'll want a pm that goes to 180 not 150. You should have a cushion of at least 10 bpm when exercising. My max rate is 175 so I try to stay under 165. You could get by with 150 but it's good to have that extra bit. Maxing out doesn't feel good, a quick way to end a workout.

I was in the regular recovery room then a room on the cardiac floor overnight, not cicu. They can do it with light sedation. I asked for versed so I wouldn't remember anything. They can also do it with just a local.

If you've been active up until now, you shouldn't need therapy and special exercises. No lifting the elbow bove shoulder level for 6 weeks, no heavy lifting for the same time. Other than that, use the arm normally. I found the limitations irrelevant, it hurt to lift more or raise the arm too high so it wasn't an issue. Just getting through the day was all the therapy needed.

I didn't put anything on the scar until it was well closed. After that I used medical grade vitamin e because it was itchy. Aloe or anything natural without added colors and chemicals will work also. I asked the plastic surgeon what she recommended. She said the important thing is to keep it moisturized, doesn't much matter what you use. Also don't let the sun on it for a year unless you're slathered in good sunscreen.

Each Doctor Is Different

by Artist - 2015-04-04 10:04:38

I was prohibited from lifting my shoulders up to a sitting
position and they strapped my left arm down so I could not use it. They took the sling off in the morning, and the prevailing opinion seems to be that wearing a sling after surgery can be harmful and cause problems with the shoulder locking up later on.

Therex

by kbell - 2015-04-05 01:04:30

I believe the exercise is aimed at kinesiology techniques to deter the pec from affecting scapulothoracic rhythm. In my case, I was given an O.T. referral and have great insurance so I am using it! I will make sure to ask about the top HR settings.

Successful

by kbell - 2015-04-09 03:04:46

I'm resting in a step own unit after getting my pacemaker. They planted it sub-pectoral just like I asked and closed the top layer with dermabond. I was allowed out of bed after an hour. The cardiac team said they were amazed how well I conducted with stim only to my sinus node. I guess it's rare to have just one conductive issue and nothing else wrong. So just a single lead in my right atrium and I easily achieved 180BPM. The Medtronic rep was amazing, I have an Adapta with an MRI safe lead, so no issues should I need one. And some type of new technology for complete reporting on the chambers from a single lead.

The surgery, pain control, etc have been a lot easier than I imagined.The only hiccup I have is a tiny 1.5 centimeter pneumothorax in my left upper lobe, which they advise is more common with sub-pec placement and should resolve on it's own.

I'm so happy I found this site! You all eliminated a lot of anxiety by taking away the unknown.

Great site and thanks to all contributors

by JillD - 2015-04-13 11:04:46

I'm very new to the world of pacemakers. I am a 60 yr old female who had a dual pacemaker implanted a week ago today.
I'm finding reading your comments very interesting and informative.
I didn't get to do any research before it was implanted - apart from what the cardiologist told me- as it happened very quickly.
I'm on a real learning curve.
I was wondering what to put on my now very itchy wound - thanks for that info.
It seems many things are done differently here in NSW, Australia compared to the US.

You know you're wired when...

Your pacemaker receives radio frequencies.

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