Atrial lead shut-off

Hi fellow pacers...

I had a pacemaker installed on 3/31/15 due to bradycardia with a HR in the 30's and several episodes of near-syncope. I woke up in recovery and was told I needed to be taken back to surgery due to lead wire displacement. That same day, they opened me back up, repositioned the wires and sutured them back in place. A day later, I began experiencing diaphramic "hiccups" and a chest x-ray showed the atrial lead had moved. They operated the next day and repositioned the wire yet again.

About a week ago, I began feeling sporadic "hiccups" again and when I went for my pacemaker check today, I was told the atrial lead wasn't capturing, so they shut that lead off and right now, I am receiving ventricular pacing only. My HR has gone from being in the 70's at rest, to somewhere between 60-65. I was told to come back for another pacemaker check In 4 weeks and if I am doing okay, I won't need to go back for 6 months.

I'm feeling like they have just given up on me and wonder whether I should seek the opinion of another cardiologist, or just leave things as they are and hope for the best. I dread going under the knife again, but I've been through so much in the last month, I'd hate to ignore the problem and risk making things worse in the long run.

Any thoughts or suggestions anyone is willing to share would be appreciated so very much!

4 Comments

I guess the big question is

by IAN MC - 2015-05-05 01:05:18

what your check-up shows in 4 weeks time . It would seem that your major problem of a resting HR in the 30s has been solved and now that it is in the 60s then your near-syncopes should be a thing of the past !

That's the good news ! Sporadic hiccups , caused because the phrenic nerve has been inadvertently included in the circuit, are uncomfortable but not dangerous.

You didn't mention if the Dr tried to cure the diaphragmatic pacing by altering the PM settings; simple measures like reducing the power can often solve the problem . The higher the voltage the greater amount of tissue is excited and in turn the greater the chance of the phrenic nerve being stimulated which can lead to hiccups.

Another simple measure which may work is to change the polarity i.e. the direction of the electrical charge.

So re-programming the pacemaker often means that no physical change need be made to the lead. If your guy didn't try these changes and went straight into scalpel mode then I would think about getting a different cardiologist / EP.

I suggest that you ask him a few questions about exactly how he tried to remedy the problem; but maybe all will be found to be well at your next check-up . I hope so. I couldn't work out if you are still having the hiccups or not.

Best of luck

Ian

answers

by Tracey_E - 2015-05-05 01:05:55

I would absolutely get another opinion. Do you know what caused the brady? That just means slow rate, many things can cause it. I'm going to guess you have av block, which means the atrial lead is there for information but you primarily pace with the ventricular lead. If that's the case, it's a judgment call if you should try to place the lead again. If you don't need it, you feel ok, and don't want another surgery, then you may be able to leave it alone. However, if you need that lead, it's best to fix it now rather than wait. You have a window of about a year during which it's easy to move it, after that it gets considerably more complicated.

I have av block but developed a second problem a few years later so I now use my atrial lead. Not much, 2-4% of the time, but it makes the difference between working out and not. Not saying that's going to happen to you, just pointing out that in my case the right decision would have been to have two working leads even tho it only appeared I needed one.

There are two types of lead, one has a barb and the other has a screw. Sometimes our heart wall is not compatible with one or the other. Unfortunately the only way to know this is what you've just gone through. If they try again, they may want to use the other type. Sometimes our hearts are shaped such that the leads are difficult to place well. Some drs are more skilled than others (tho my guess would be one of the first two scenarios is the case, it was working when you left the OR or they wouldn't have closed). Or sometimes we just have really rotten luck. I would want another opinion as to why the lead has dislodged twice, and if you do need it moved again I'd want someone else doing it.

And to answer the question in your profile, there is no reason to think once you get past this that you won't live a full, active, healthy life. Sometimes it seems like there is no light at the end of the tunnel but most of us have structurally normal hearts with an electrical short. Once they get the pm set for our needs and we have a chance to heal, life goes on. I'm the same age as you but have been paced for 20 years now. No one would look at me and see a heart patient. I hike or ski most every vacation, do Crossfit 5 mornings a week, kayak and zipline every chance I get. It's a shame you've had a such a rough time but please know that there is every reason to believe this is all temporary setbacks, not an indication of the future.

Good luck!!

Thanks for the quick replies!

by staleebabbit - 2015-05-05 02:05:38


Tracey, my stress test and echocardiogram showed no av block or structural damage to the heart. I was told I have sick sinus syndrome and that though they couldn't say what caused the bradycardia, but that the pacemaker would fix the symptoms I was having. Still, my fear is that I might need the atrial pacing (the tech told me today my atrial pacing was at 65%) which seems rather high to me to just have it shut off. I'd be willing to deal with the hiccups if the atrial lead is necessary and is doing its job.

Ian, the tech did attempt to adjust the settings to lessen the hiccups both today at the office and the last time the lead had moved while I was hospitalized, but to no avail. Today they asked me to wait for the doctor to arrive to see if he wanted me to have a chest x-ray to check the leads, but after he spoke to the tech, he jokingly said he was done with me, that he was divorcing me...everyone laughed, the doctor said I'd be okay and told me to come back in 4 weeks . Not exactly the reassurance I had hoped for.

I'm thinking another opinion is the best way for me for me to get some peace of mind and will do that ASAP.

Thanks again for listening and for offering the benefit of your opinions :-)

SSS

by Tracey_E - 2015-05-05 04:05:56

If you have SSS, all of your pacing is atrial so turning off the lead doesn't make much sense. Could it be the ventricular lead rather than the atrial? Something isn't adding up.

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