Possible Lead Replacement

I am a 53 year old woman who has AV block. I've had a dual-chamber Medtronic PM with first implant in 1983 and am going on surgery #6. The first 4 years were rough: infection, erosion, lead replacement. in 1987 I found a great doc and that PM lasted 12 years. I had it replaced by him again in 1999 and it lasted 10 years. My current PM was put in by another doc in 2009 but needs to be replaced already. The leads are are 27 years old but according to the Medtronic reps who check it, the leads are still functioning. My doc is suggesting lead replacement. After doing some research, I am not too keen on this option since I haven't been having any issues except that the PM didn't last as long this time around. It seems to be a very risky procedure. Any thoughts? I live in Dallas, so if you have any experience with a certain hospital/practice here, that would be helpful. Thanks.

8 Comments

Leads

by golden_snitch - 2014-08-29 02:08:30

Hi!

So, you still have only two leads in, and these two are 27 years old?

With only two leads in, if one breaks one can place a new lead without having to remove the old, broken lead. Usually, one starts removing old leads when there is not enough room for new leads, but in most patients three or four leads in the vein are okay.

As long as the 27 years old leads are functioning well, I'd probably not agree to replacement or placement of additional, new leads, if I were you. And even if a lead breaks, I'd rather not have a 27 years old lead removed as long as there is room to just add a new lead, instead of replacing an old one. But that's just my opinion.

That your pacemaker didn't last as long as the old ones can have different reasons. Maybe the threshold has increased over the years due to scar tissue around the tip of the pacemaker leads. That typically drains the battery more quickly, because the pacemaker then needs to stimulate with a higher output. So, the lead is still fine, but effective stimulation is difficult due to the scar tissue. In this case, new leads need to be placed in a slightly different spot. Lead fracture or insulation fracture is another reason why a battery could deplete sooner than expected. But if the Medtronic tech says the leads are fine, then they are fine. There are certain parameters (most importantly "impedance") that indicate when something's wrong with the leads.

Hope this helps.

Inga

My thoughts exactly

by vvg61 - 2014-08-29 07:08:39

I am meeting with an EP next Thursday. I'm hoping that he will be able to test the leads somehow to see if we really need to replace. I believe that my current doc is recommending this just because of the age of them. Yes, to my knowledge they are both 27 years old. In 1987 my PM was moved from right side to left and they extracted leads old fashioned way: yanking! I was awake for it and remember it. At that point had only had a PM for 4 years. I cannot imagine that even with the laser sheath it wd be possible to get them out after this long. I wd prefer capping and going back to right side or running another wire in same vein if possible. I'll let you know what EP says after I meet with him. I think he is the only one in my area who does the extraction procedure. I keep hoping for new options but not sure they'll be ready in my lifetime.

extraction

by Tracey_E - 2014-08-29 09:08:11

It's not as risky as it used to be and it's easier to find someone experienced, but for those of us with very old leads, I would only extract as a last resort. I figure the longer I wait, the better they'll get at it! I'm 47 with 20 year old leads so I assume an extraction is in my future, but if I put it off long enough maybe I'll only have to do it once. I'd only add a new lead if I had to, try to put it on top of what's there rather than extracting. Another option is moving to the other side. But if it's working and not draining the battery excessively, I'd leave well enough alone.

12 years is fantastic! Mine have never lasted more than 5-7. I have av block also, got my first in 1993 and am on #4. I got one new lead last time, added it and capped off the broken one.

space

by Tracey_E - 2014-08-30 09:08:04

When we were trying to figure out what to do, they took me to the cath lab and did an iv with dye (venogram). I didn't want to go into surgery not knowing exactly what we were going to do so that's what the ep suggested.

We have a few members with leads 30+ years old! I think drs freak sometimes just because of the age but it's not their bodies, you know? You should talk to Gellia. She's not on very often but you might be able to reach her via private message.

Old Leads

by Good Dog - 2014-09-04 11:09:59

I have three leads one of which is 27 years old. The reason I have three is, because one of the original leads was recalled a year after it was implanted. So when I went in for my first battery (generator) change they inserted a new lead and capped the old one.
My doc advised that even though the risks associated with extraction are very low, he doesn't think it is wise to extract unless it is absolutely necessary. I certainly agree. I am hoping that I can get at least 50 years out of it.
I would certainly be interested to know how old the oldest leads are.......in-other-words.....how long can they last??

Advice: Keep it coming

by vvg61 - 2014-09-06 04:09:50

I so appreciate having others to talk to about this procedure. It helps more than you know.

I saw EP on Thursday and he is recommending lead replacement. I expressed my concerns about it and asked why we cannot just cap the old and run new. His response was that they don't like to leave hardware in the body because it cd cause more problems later. Also, since I'm youngISH ;) I will likely need several more PM replacements.

This doc says he does 80 to 100 extractions a year, on the lower side of what I read s/b the minimum. He seems to be "the" guy in Dallas for this procedure. I expect that most don't want to touch it. He got his laser training when there was a big recall of afib leads maybe 15 years ago and has been doing it ever since.

We are going to do a venography, chest X-ray and echo this week. I am so hoping that the whole lead removal idea won't pan out. He said that often when they've been in the long, the vein kinda "shrink wraps" around the lead .

My trusted cardiothoracic surgeon who cleaned me up after the Major Infection of my youth is retired now but I am considering calling him for advice. Does that sound crazy?! As you can probably tell, I am pretty freaked out. I'm not afraid of dying (well maybe a little) I'm just afraid of leaving my 16 year old daughter without her mother at such an important time in her life.

Thanks for listening. I know there is someone who can probably relate.

His Response

by Good Dog - 2014-09-06 05:09:55

Not so sure his response would be acceptable to me. I would certainly think that I deserve more than that explanation.
Given that many of us have more than two leads and live without issues, there needs to be a better reason for extraction. I mean that if your doc is not giving you options, one must assume that it is medically necessary for some reason beyond "extra hardware". A better explanation and/or a 2nd opinion would not be out of order.
Sincerely,
David

Hard choice

by lynn1234 - 2014-09-08 03:09:53

I can relate somewhat to what you're saying as Im facing a similiar situation. I have vegatation on my leads and right now they have me on Coumadin to prevent blood clots. I have an appoitment wit EP 30th October.

Ive had mine for 15 years and 3 pacemakers.

Good Luck

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