Two Lead Dislodgements

Hi I am 39 years old. Got a PM in 21-7-15. 15 days later it was discovered that the Atrial lead had moved. Got repositioning done in 12-8-15. While in ICU after the repositioning, the doctors discover that now the ventrical lead (RV ) had moved. But the doc lied to me and told me that all is fine and discharged me the day after.

I was suspicious so I went to another doctor who saw my fluoroscopy report and confirmed that the RV lead was displaced. Since then i have taken opinions from various doctors. Following are their observations.
-The RV was displaced and now in the lower part of the atrium and is sensing the atrium.
- All docs say that I don't need the RV lead as my lower chamber is working perfectly. Actually they very much doubt if I even needed the PM in the first place.
-Most doctors are saying that I should still go for 3rd surgery to either get the loose RV lead removed or repositioned as the wire can move again screws at the end of wire could pose a theoretical but possible threat.
-But Couple of docs are of the view that I should leave the wire as it is as I don't really need it and if the wire stays where it is for 3-4 months, chances of it moving and causing trouble are almost negligible. The risks of infection in a 3rd surgery should also be weighed.

My life's come to a standstill for he last 3 months. I am quite apprehensive about a 3rd surgery as I have had terrible time even recovering from the 2nd surgery. Please advise if I can leave the loose wire as it is and move on with my life ?

8 Comments

Moved lead

by Good Dog - 2015-10-10 10:10:27

If it were me, I would have it re-positioned so that it can be used if needed. It could be useful if for no other reason than to track the ventricle. If you have a dual chamber PM it might preclude the need for a third lead in the future. At your young age, you don't want to have any more leads than are necessary.
Please understand that I am just speaking from my perspective (as if it were me). If you feel differently, I certainly respect that.
I had to go back into surgery a second time after my second generator change when a third (new) lead was added. It had moved.
In any case, I would not have it extracted. Extraction can be risky, while re-positioning is pretty safe and easy.
Wishing you the best,

Dave

Lead perforated through ventricle

by erica2168 - 2015-10-11 04:10:14

Hi, my name is Erica. I'm 21yrs old and this past week I have experienced similar to what you have going on. For the last several weeks I was complaining of this sharp like poker feel right on my apical. It would come out of no where. Went to the ER - got a Cat scan and they said I was fine and discharged me at 3:30am. I received a call the next day that to come back and see the cardiologist who was iffy about what my symptoms are. He didn't believe that it could be the lead until the Ct scan was brought in and you could see my RV lead perforated through my Right ventricle. Even though this surgery should have been done right away .. they made me wait 2 weeks and at this point the pain got worse.
The first Thursday of October I went to the hospital and they agreed it was perforated and that the lead needs to come out. I had a thoracotomy and lead extraction. I made the decision to put back my RV lead and they found that I had several clots in my right atrium from the perforation.. they were able to retrieve them all except the biggest one that runs from my subclavian artery to the flap of the tricuspid valve. I am now on Coumadin and just stopped taking heparin shots due to my INR being at an acceptable level. I will be taking coumadin for several months and then have a TEE performed to see if the clot is still present.

From your story, I really think you should consider taking it out. Because if it is loose.. you don't want to run the risk of bleeding like me and create clots. Extractions are an easy procedure and If you need a second opinion I would highly recommend Hospital University of Pennsylvania. Thats where mine was done!

What % of the complaints represent?

by laupek9 - 2015-10-11 05:10:33

What we read in this column are mostly complications and problems faced by patients having PM implanted. What is this percentage of overall and total implants done. I am about to have one soon. After reading all these I'am quite worried.

What % of the complaints represent?

by laupek9 - 2015-10-11 05:10:57

What we read in this column are mostly complications and problems faced by patients having PM implanted. What is this percentage of overall and total implants done. I am about to have one soon. After reading all these I'am quite worried.

Hi laupek

by IAN MC - 2015-10-11 10:10:28

You ask a good question. The percentage of PM patients who experience complications / problems is really TINY but this forum attracts them.

I am really glad that I did not know about the PM club before having my implant . It would have scared the s***t out of me and I think in many ways the PM club should carry a health warning. I now personally know 9 people with PMs and every one of them sailed through the whole implant process/ recovery without any problems whatsoever .

Around 4 million people now have pacemakers and I believe that the 9 who I know are typical of the vast majority of them

Having said that ,the PM club can be invaluable for the very unlucky tiny percentage where things don't go smoothly but the chances of you being one of them is remote.

I hope you make the right decision Prash , only you can make it !

Best of luck

Ian

Prash

by Good Dog - 2015-10-11 12:10:30

I have given your situation a lot of extra thought. I do think that Erica is correct. Given that this lead is fairly new, and you are young, extraction shouldn't be that difficult. I would either have it re-positioned or extracted. I know it isn't something that you look forward to, but it may be the best option. That said; I would certainly understand if you choose to do nothing.
It remains your choice and given all the facts, you will make the right decision for yourself.

For others who are reading this; pacemaker implants are almost always successful. Like any other surgery, there are things that can go wrong. However, those happen in only a very, very small percentage of cases. It is rare!
Just be sure to have a lot of confidence in your doc. Get and check references. I can't know all the facts in these situations (Prash & Erica). I had a new lead move and my doc caught it and re-positioned it quickly after the initial surgery. I believe that these docs should have done the same.
I had a pacemaker implanted at a young age and if I had it to do over again, I'd do the same thing!
Sincerely,

David

Thanks

by Prash516 - 2015-10-12 04:10:50

Thanks Good Dog for your views . Also Erika for sharing your experience. Hope things improve for you really soon. This really helped. Will be taking the decision very soon.

Opinion

by jvaltos - 2015-10-13 01:10:47

First, the pacer wire should be repositioned, easy to do and little chance of a problem.

Second, ask for another opinion please.

Third, sometimes wire move even if implanted perfectly. My suspicion is that the RV lead was dislodged when moving the atrial lead and then simply didn't check it at the time of the RA lead revision. Not good form...

Good luck.

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