"noise" on lead

I had a my original (2003) Boston Scientific battery replaced this past July but no lead replacement. Starting about a year ago the techs started noticing what they call "noise" on my atrial lead. I was asymptomatic so they did not recommend any action. Recently however I am having episodes of feeling lightheaded and irregular beats that feel as if someone is running me through a prolonged pacer testing. during these episodes, I feel weak and nauseous and afterwards, wrung out. No pain, just irregular beats and some of the feelings I had when I had my original 3rd degree block, faint, dizzy, sick.
they recently adjusted my pacer so it would not be as "sensitive" and stop reading the noise as a need to pace, thus causing the increased beats and symptoms, however that has not eliminated the problem.
Anyone have a similar situation and any solution..should I be getting a new lead? I am almost totally dependent...still have a very slow 30bpm when unpaced.

5 Comments

Well, to start.....

by donr - 2014-04-20 09:04:39

.....Welcome aboard, retail girl!

NOTE: Edited at 0807, EDT to add para 3) & to add a word in 2).

Nice to know that you are from the USA - that narrows your identity down to 1 out of nearly 350 Million people.

Sure wish you'd told us WHY you got the PM to start with. Was it JUST a 3rd degree block? Or is there a bit of SSS thrown in for good measure?

Let's address the specific question - noise on the lead. WHICH lead? Atrial or Ventricular? Makes a big difference.

Noise - it can be any one of a number of things happening:

1) Spurious electrical activity that the PM senses through the affected lead as "Noise." Could be coming from your heart, or perhaps a quivering, pulsating muscle nearby.

2) A lead w/ a crack in one of the two conductors in the lead - assuming that you have "Bipolar leads." Most PM's use them today. If you have a crack in a lead, the electrical resistance changes as the two adjacent sections of the crack rub together. This could cause the PM to think that there is electrical activity in the heart that causes it to inhibit itself & NOT send pacing pulses to the affected section of the heart w/ the bad lead.

3) An extension of 2) above - if there is a crack in the outer conductor, or the insulation surrounding it, intermittent short-circuiting to the body tissues or fluid could cause the noise.

Since you describe the symptoms as the same as when you had your original 3rd Degree block, sounds like it's your ventricular lead that's noisy.

They should be able to diagnose its problems & be a bit more specific. Won't be easy, by any stretch.

Sounds to me like some wishful thinking on the part of all your providers when they changed out your original PM. Wishful thinking that failed.

As an engineer, I'd have gone in while they had you open & pulled that lead - usually things that are acting like this just don't fix themselves. Matters not whether they are mechanical, electrical or biological. That's just the nature of complex systems.

Donr

"noise" on lead

by retailgirl - 2014-04-21 10:04:47

Thanks for the info Donr. Well, they did not mention any SSS and the PM implant was done on an emergency basis after passing out with 3rd degree block diagnosis resulting. The most recent tech said it is the atrial lead with the noise on it.I am seeing doc again today hopefully (after a very bad episode of symptoms most of yesterday,) and another pacer check tomorrow. Had no problems at all with PM (hardly knew it was there) even with very active life..swimming,exercise,etc for ten years. Only having symptoms recently since new battery implant in July.

Hmmmmm - Atrial Lead...

by donr - 2014-04-21 12:04:27

...That rules out a lot of the problems caused by a 3rd degree block. That is ALL AV node & a conduction problem between the two node.

I'm no EP, but this sounds a lot like an SSS problem, since it's the Atrial lead w/ the noise - OR ELSE - you have developed some other type problem involving the Ventricular pacing & the Atrial lead is contributing nothing to the situation.

As a final thought - Electrical problems can crop up suddenly - witness your implant on an emergency basis! Something well could have changed since the PM implant 10 yrs ago.

I think you need to ask about those possibilities. I'll even throw in a Horseshoe at this point (Really need a ringer). The noise may be something that is generated elsewhere & sensed by the Ventricular lead so it inhibits itself from pacing the Ventricles.

One clue might be a significant change in pacing percentage by the ventricles. If it suddenly dropped after having the PM replaced last yr, That can explain the crappy feeling. After all you established a ten yr record of feeling well.

Which leads to "Don's Second Rule of Diagnosis," which say "When something goes wrong, revisit the last issue worked on."

Followed by "Don's Third Rule of Diagnosis," also known as the "Sherlock Holmes Rule:" "Rule out all that is impossible. Whatever is left over, no matter how improbable, is the answer."

Oh, BTW: The first rule is called "Occam's Razor," "Choose the simplest explanation first - it has the highest probability of being the answer."

Donr

noise on lead

by retailgirl - 2014-04-22 07:04:39

Just returned from yet another pacer test, this one more detailed and investigative. they tell me today that there is fairly consistent "noise" on both leads which they suspect is external. they tested both leads and said they are both working perfectly but there is some environmental or external source of interference showing up. they do not think it is responsible for the recent palpitations and episodes of rapid beats and lightheadedness I am having. We are all at a loss as to what this external source might be. I am now scheduled for further investigation of my symptoms since they appear to have ruled out anything related to the pacer. any thoughts? I don't use power tools, rarely a cell phone, no magnets around, no high voltage wires....

Hmmmmmmmmmmm!!!

by donr - 2014-04-25 01:04:42

No one wanted to stick a neck out on this one. Guess it's mine by default!

I had sort of this problem when my lead broke at the 4th yr.

Took a while to determine what had happened.

This is a new situation - NOW BOTH leads are noisy. Before it was just the Atrial lead. That, in my book, does NOT pass the common sense test for a 3rd Deg block - unless, as I speculated, there was an OUTSIDE source causing the problem.

Let's check out my SECOND rule of trouble shooting - Do you know what your pacing percentages were before & after having the PM changed out? If they are significantly different, that's where the genesis of the problem is - the new PM installation. W/ noise on BOTH leads, I'd look at a possible intermittent short circuiting between the two leads, first at the point where the leads connect to the PM can & then further down the line.

You stated that the noise in the Atrial line began a yr ago, but you were asymptomatic - that makes sense - the Ventricular section was pacing you every time that the Ventricles did NOT contract on time - as the PM should have been doing.

But NOW after the new PM was installed, you have "Severe" issues. I'd look at the installation of the new PM. Perhaps it has an internal glitch inside the can - or they damaged the connection between the old leads & the new can.

It's time for someone to get imaginative & start looking at the more complex, less probable solutions.

Donr

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