Phrenic nerve problem

I've had a pacer for 6 months for a left bundle branch block. Since the day of the implant I've had phrenic nerve stimulation to my diaphragm . The doctor and tech have tried every type of voltage adjustment and drug changes. This past week my doctor told me that since the adjustments are so low the pacer is not helping me. He has suggested replacing the left lead ( which is a 4 vector wire and replace it with a 16 vector wire )and the pacemaker asap to solve the problem. Does anyone have any advise ? Should I go get a second opinion ? Thank you Papajoe

3 Comments

Quadripolar lead

by golden_snitch - 2014-09-22 09:09:24

Hi!

I guess with a left bundle branch block your pacemaker is a CRT device pacing both ventricles, and the one for the left side (the coronary sinus lead) is causing the phrenic nerve stimulation. This is a quite common problem with the left ventricular leads in CRT patients.

Here's an interesting article about the lead your doctor was talking about:

http://www.cxvascular.com/crn-latest-news/cardiac-rhythm-news---latest-news/fda-approves-attain-performa-quadripolar-lead-and-viva-quad-crt-ds

Sounds promising. And if your doctor is going in anyways, I'd say: get the lead replaced with the quadripolar lead. I am not sure he could actually relocate the old lead, because there is not alternative site in the coronary sinus and moving it a little further down or further up probably doesn't make a big difference. He's not moving a lead that is placed somewhere inside the ventricle, but one that is placed in a vein that runs on the outside of the left ventricle.

Inga

leads

by Tracey_E - 2014-09-22 09:09:34

If it's stimulating your diaphragm then moving it is appropriate. I don't know anything about 4 vs 16 vector, I thought they could use the same wire, just relocate it.

If you are at all uncomfortable with the dr and what he is telling you, then get a second opinion. It's important to feel good about your decision.

Hola

by PacerRep - 2014-09-23 01:09:18

I will have to reluctantly disagree with golden Snitch. There's nothing wrong with the quad pole but since that other lead is already in there, moving it even just 1-2mm (pulling on it) changes everything. they have the ability to test all the vectors prior to closing you up. I highly doubt they are going to want to replace the whole lead when they can give it a quick tiny pull.

But it doesn't hurt to ask, just increases your risks.

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