leads

Just sent a message to my Cardiologist's office. for the past few days I have had hiccuping in my lower left side. I would have waited until my next appointment which is not until Sept. after reading a member's post on her leads kept coming out. I started to reconsider that thought since I have had some problems in the past with my leads. on may 17th of this year had my procedure done. less than hour later when in x-ray my LV lead started pacing my diaphragm. so the next day the Doctor had to go back in remove that lead. he put in a new one that had j shape to the end of it. he said it was not going to move. then a couple of weeks later he noticed the lead in the rv had pulled back some. it was still getting the job done. I am not gonna lie I am pretty bummed about this. I just wanted vent. I am so relieved to have this site to come to. thought I was in the clear. feeling great, can even run on the treadmill now. something that was impossible before. I am beating myself up wondering what I did to dislodge the lead.

6 Comments

Probably NOTHING

by donr - 2013-08-25 06:08:25

I'm sure that you did not swing from the chandelier in your dining room by the arm on the PM side while eating a banana with the other hand. If it were just a few hours later, at best you were groggy & merely thankful to be awake. The surgeon just did not get the first lead implanted well enough.

Now for the second lead - If you still feel good & the lead is apparently doing its job. You have a 3 lead PM - how are the three leads routed? Is one of them external to the heart? Which one? My guess is the LV lead, since when you go into the heart through the subclavian vein your access is into the RIGHT side of the heart.

Is it really dislodged? At this point, can you really be sure, since it is still working (you reported in your post.). What is exciting you now? Its was a matter of weeks between implant & him noticing it had pulled back a little. At that point it should have been well entrenched in the heart wall & held by scar tissue.

Are you feeling any symptoms other than the Hipcupping or just bummed because it may not be where it is supposed to be?

Don't blame you for sending an e-mail - hope you get it resolved satisfactorily.

Don

Biventricular pacing

by Selwyn - 2013-08-25 08:08:37

I think more and more people, these days, are having biventicular pacing with access to the left side of the heart via the right side, using the 'back passage' of the coronary sinus to reach the left ventricle wall.
( see http://my.clevelandclinic.org/heart/services/tests/procedures/biventricular_pm.aspx for review and for anatomy, http://en.wikipedia.org/wiki/Coronary_sinus).

Lead displacements are commoner in biventicular pacing even in experienced hands; given the amount of fiddling to get the lead into the coronary sinus ( which is on the outer surface of the left ventricle wall which is naturally moving), you can see why they dislodge. It is, as Don says, not your fault for having a heart beat! Don't beat yourself up over this, these things happen.

I can only admire the skill necessary to thread a catheter into the coronary sinus in the first place.

Leads

by Vinnie - 2013-08-25 09:08:51

I had my CDT-P put in on June 26 2013---- over the past 5 weeks I had a similar problem of hiccupping on my lower left side. I mentioned this to my EP ( the one that installed the wire ) and asked him if it was possible that the lead was installed close to the nerve that controls the diaphragm ---- he said "possible" but he didn't elaborate. After seeing the EP I started keeping track of the hiccupping and I noticed it happens at 3:00 am --- 3:30 am & 4:00 am every morning. I get up every morning at 2:30am ( I'm 76 and it's a habit )--- I get 2 beats on the left side just above the belt line and it's every morning at the exact time. Otherwise the pacemaker seems to be doing it job as I feel much better with the CRT-P than with the dual chamber I had before. I plan to ask him more about the hiccupping when I see him next---FYI the CRT-P is a MEDTRONIC CONSULTA

To DonR

by PacerRep - 2013-08-26 12:08:23

in almost all cases now a days all 3 leads take the route your suggested...either Subclavian or cephallic (young patients sometimes get an axillary for cosmetic purposes) down the SVC. The LV will go in the CS as selwyn highlighted. One of the reason's leads do dislodge is the lead is going against the blood flow current, kinda like swimming upstream in a river, that's why they have a J or S shape on them to wedge themselves on the wall. No docs today will do an Epicardial first unless there is an anatomy issue that prevents a traditional CS implant

Lead probably moved

by PacerRep - 2013-08-26 12:08:42

High probability that the lead did move. But don't sweat it just yet, CRT's these days have up to 7 different electrical vectors we can try to "program" around the stim. I would bet a hundred bucks that I could induce stim in anybody with a Bi-V....the point of that comment is to highlight the fact that it's possible in all leads of all positions.

So your lead moved...you are programed for a different position...they need to reprogram it.....Now if that doesn't work and you do have to go back in for a reposition there are a few options I would consider since this will be your 3rd time (we don't consider these on a first dislodgement).

Epicardial leads, they go on the outside of the heart via a thoracotomy. Bigger surgery, your pretty darn sore but that lead isn't going to move....ever....ever.

Starfix- This is a special endocardial lead (what you have now) with an active fixation vs the passive one you have now (that J shape...its kinda like an S shape that more or less wedges itself in the vein). The starfix is implanted the same way as your current lead...the drawback is it is never coming out, once it's in...it's in. So if it fails in the future and you need a new lead...your getting an epicardial for sure.

With 2 dislodgements and again if it can't be programmed around...you probably have some pretty big vessels, so I would consider one of these 2 options just to ensure your done with it.

Thank you

by coppertop - 2013-08-27 06:08:46

I did get in yesterday. all leads are still in place.
Thank you so very much for the feed back.
I was told the hiccups can happen as everything is settled in it's place. I was also informed I am 100% paced.

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