External pacer wires

• by swmfast
• 2014-02-24 03:02:28
• Complications
• 1458 views
• 2 comments

I have been monitoring this site for several months since getting a PM in July 2013 for complete heart block and have found it to be very informative. I have never joined any type of on line community but decided to make the jump into this community in the hope that I find some answers to the some issues that I have been dealing with since my PM surgery and others which I just popped up after an adjustment to my PM two weeks ago.
In 2008 I had a double CABG due to partial blockages of the Left Main and LAD arteries. My surgery did not go smoothly.During the course of the surgery, they discovered that I had a bicuspid aortic valve which was seriously failing. After consulting with my wife, they replaced the defective valve with a mechanical one. They also found out that I had very friable arteries - meaning that they break easily. As a result, they had difficulty getting one of the bypass graft to hold and had to deal with the aorta tearing when they were seating the article aortic valve. To make matters more interesting for the surgeons, I had a reaction to the heparin given to me during the surgery. Thankfully I was blissfully unaware of all of these complications. Post surgery I had some further complications due to my chronic kidney disease and a post surgical med that caused my one remaining kidney to start failing. The reason I mention all of this is because, as a result of all this excitement, the pacer wires that were placed on the outside of my heart during the surgery were left in place instead of being removed - a fact that no one discovered (or at least no one told me about) until two years later when the wires showed up on a CT scan. By that time the docs told me that the only way the wires could be removed was a second open heart surgery which was not something I am willing to go through unless absolutely necessary.
Due to the problems that they had attaching the by-pass graft that kept breaking during the surgery, I developed a lot of scar tissue which caused one of the by-pass grafts (the one to the LAD ) to fail within 6 months of the surgery. The other by-pass has not had any problems and has provided enough back flow to the area of the heart served by the failed by-pass graft to avoid the need for another by-pass surgery.
To my knowledge, I never had any electrical issues with my heart before the by-pass surgery. Within 2 years of the surgery, I developed right and left bundle branch blocks which did not seem to concern my cardiologists. In 2012 and early 2013 , I had three syncope episodes each of which only lasted a few seconds. After the first two, I was placed on a Holter monitor and then a 30 day event monitor both of which showed nothing. After the 3rd incident, I think my doc thought that I was just making everything up, because when I asked him what I should do if I had another syncope event, he told me just to get up and go on with whatever I had been doing. The 4th and last incident occurred during my cardiac rehab class. I was about to follow my doc's directions and just ignore the incident, when the nurse running the program did a rhythm strip on me which showed I was in complete heart block. 6 hours later I had my PM. The surgery was uneventful.
2 weeks after my PM surgery I developed pacemaker mediated tachycardia (PMT). The doc's made some minor tweeks to my PM which resolved the problem.
I am paced at 60 BPM. I have had some minor discomfort when I am being paced. When I mentioned this to the doc's they said it would away with time. It has not but it has not been much of a problem because until about 2 weeks ago, I was only pacing about 10% of the time. About 2 weeks ago I went in for a 6 month checkup on the PM and they made some further " minor adjustments" to my PM. Within 4 hours of the appointment, I began experiencing palpations, a fast heart rate and moderately severe angina. When I reported the problem to my doc's I expected that they would tell me I was just having some more PMT and that they would just have me back into the clinic to make some further adjustments to my PM. To my surprise, they had me go onto a 30-day event monitor without even seeing me back in the clinic to check my PM.
I have been on the monitor for a week now and have had multiple events every day. I have been monitoring my own pulse using an app on my cell phone and my blood pressure monitor. I have noticed the following patterns; 1. On some occasions, my pulse will suddenly jump from my normal resting pulse of around 65 to 95 to 100 BPM and just as suddenly jump back to 60 BPM (my paced rate). This has occurred repeatedly while I am doing nothing more strenuous than sitting or standing. 2. I am getting the angina whenever I am being paced. 3. About 50% of the time, when I have checked my pulse during the past week, I am being paced.
All of this is background for my questions: 1. Has anyone had any experience with a PM with external pacer wires still in place after by-pass surgery? 2. Could the external pacer wires be interfering in any way with the functioning of my PM? 3. Should I be concerned that my doc's have not had me in to the clinic to check my PM settings since the onset of symptoms after their latest adjustment? ( from the way they have reacted to my recent complaints - I suspect that they just think I am either making up or exaggerating my symptoms)? 4. I have recently been diagnosed with small fiber neuropathy and am suspected to have Cardiac Autonomic Neuropathy(CAN) as a result to of that the small fiber neuropathy. Does anyone have experience with a PM with CAN? Can Cardiac Autonomic Neuropathy interfere with proper functioning of my PM?