Lead replacement

Hallo everyone,
I have had my pacemaker since I was 15, I am now 30 years old. I had my pacemaker replaced last year. They tried to put a second lead in but failed to do that because there was too much scar tissue around the lead. Now im going for another surgery to possible have it removed and then put a new one in as well as a second one. Has anyone ever had this? They are talking about complications being a big possibility. Im not scared or anything Im just curious. Especially on the recovery time?
They also asked me to do a dental assessment before the surgery?! Does anyone know why?

Thank you,
Janine

8 Comments

Piggy Backing off Golden Snitch

by PacerRep - 2013-10-23 09:10:14

The dental assessment is for open heart. During a lead extraction, one of the possible complications is that a portion of your arteries or heart could get a tear, if that happens they have to go in there...fast.

Extractions are not to be taken lightly, do your homework and find the BEST doctor you can find to do this. If he doesn't do 100 extractions a year, then I would find a different guy...just my opinion.

Most of these go just fine, but when they don't...it's a life altering change.

Open heart?

by golden_snitch - 2013-10-23 09:10:52

Hi Janine!

The only heart surgeries that require a dental assessment beforehand are open heart surgeries, as far as I know. I had one open heart surgery and had to have dental assessment and see a specialist for ear, nose & throat before surgery. I also had a surgery to place epicardial pacemaker leads, but that was no open heart, just open chest, and no assessments were needed.

You should ask your doctor about the details, because this does not sound like a regular pacemaker surgery at all. How are they planning to remove the old lead (lead removal is not that easy)? Could it be that they want to do epicardial leads that are attached to the heart muscle from the outside, and not transvenously.

Also, do you have congenital heart disease for which you had surgeries before or is it "just" an electrical problem, a heart block for instance? It patients with congenital heart disease who have already had cardiac surgeries, it can be more difficult to place new pacemaker leads. A friend of mine with CHD had to have a full sternotomy last year to place a new epicardial pacemaker lead.

Best wishes

Inga

dental assessment

by KathyB - 2013-10-23 10:10:34

In my opinion, the doctor wants to make sure your teeth are okay and no infections etc. The mouth carries a lot of bacteria and it can migrate quickly to the pacemaker and cause an infection. also can attack the heart.. I know that any time I go to have a cleaning or any procedure I must premedicate with antibiotics just prior to the procedure. Hope this helps

a dentist opinion

by Creaky - 2013-10-23 10:10:35

pacerRep has it right. In case there is a tear in vein or heart wall during the lead extraction, an existing dental infection could lead to serious complications.
Generally the indications for pre med have been tightened up alot in recent years and generally not indicated just becauses someone has a pacemaker.
Follow your docs advice.

Creaky

dr letter

by jvdinden - 2013-10-24 01:10:47

Thank you all. I got a letter from my doc saying im reffered for open heart surgery. Im working nightshift and got my letter late in the day, so I have to wait till tomorrow to find out if its actually gonna be open heart surgery or if they are just giving the worse case scenario. I do know when I did a venogram they found that there are lots of scar tissue around the lead and that not all the blood pump back into my heart but some get pushed up into the my neck.
I dont have a congenital heart problem, I have Sick Sinus Syndrome and heart block. They found that when I excercise and then take a break my heart rate suddenly drops and i feel faint or faint if its very bad (haven't fainted since I got my pm). Currently I only have one lead in place, and last year when I had my new pm installed they tried to put the second lead in but because there are so much scar tissue they couldnt put the second lead in. This trouble they had actually gave me a pneumothorax and I had to stay in the hospital a few days

VCS syndrome

by golden_snitch - 2013-10-24 03:10:19

Hi!

That sounds like you have developed Vena Cava Superior Syndrome. It's an occlusion/blockage of the vein that carries all the blood from your head and arms back into the heart; it goes into the right atrium. If it's blocked or at least very narrow, the blood cannot flow back into the heart and you get that pressure in your head and neck, you swell up etc. I have had this syndrome because of scar tissue from sinus node ablations that blocked the VCS. I had to have open heart to reconstruct the vein.

Also, if you have VCS syndrome, they will most likely place epicardial pacemaker leads. Your transvenous lead has led to the occlusion, so they will for sure not put any more leads into the VCS.

Best wishes

Inga

thank you

by jvdinden - 2013-10-24 03:10:34

Thank you very much Inga. It kinda came as a shock when I got the letter saying open heart surgery, but that makes sense. I will call the Dr tomorrow and find out as much as I can. I do have a question for you. The VCS Syndrome you had, is some of the symptoms headaches, tightness of the should/neck muscles? The tighness of my muscles/body is on my left side

Symptoms

by golden_snitch - 2013-10-24 06:10:44

Hi!

Headaches definitely, and then I had lots of pressure in my head and neck area. Could be that for you this feels like tight muscles. I was hoarse, had a cough, shortness of breath, swelling in the face and upper body, especially upper arms. I needed several pillows to be able to sleep because laying flat made the symptoms worse. Do you feel pressure in your head when you bend over, get down on your knees or lay flat? That would be typical, too. When I was diagnosed I also had a pericardial effusion, with beginning of right heart failure, so they said that some symptoms, especially the cough, were rather related to this than to the syndrome.

Hope you get this sorted out soon. I can imagine what it shock is was to be told, all of sudden, that you need open heart surgery - been there, done that. Just that in my case I didn't get the news by letter, but was already in the hospital as an emergency case.

Good luck!

Inga

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