SHARP STABBING PAINS IN CHEST AFTER IMPLANT

I had a Dual lead Boston Scientific PM implanted 7/19/16 in preparation for a future AV Node ablation to fix my proximal SVTS and AFib. Base rate was set to 50 since my previous resting rate was 55 to 57. Overnight observation went well and BS tech said PM and leads test good but data showed I was paced 40% of the time. Doc chalked it up to affect of general anesthesia  and I was sent home with arm restraint. I took my pain pill, antibiotic and went to bed. Following morning I awoke with just the expected incision soreness and my arthritis back pains. I took it easy, just resting all morning then sat at my desk working on my computer. As I leaned forward I felt very short duration electrical stimulations at heart rate around my sternum. I leaned back and I didn't feel it. I went to lay down and started getting severe sharp stabbing pain in ribs just left of sternum and below pectoral. I stood back up and the pain stopped but if I twisted my trunk it hit again with a vengeance. I was not dizzy or short of breathe and could find a position without the pain even taking a deep breathe. 

Immediately went to ER where they did an ECG and drew blood to check for a heart attack. HR was rock solid 50 but looked normal, O2 was 87% and i still had the stabbing pains in certain positions.  No evidence of heart attack. No explanation of why now severe bradycardia such that I was now reliant on PM for at least 50 bpm nor cause of stabbing pains. They could not even run diagnostics on my PM but did contact my EP who requested chest xray and conclude leads still in place. Their conclusion was " take pain meds and rest".  My EP called next day to move up followup. BM tech determined RV lead was dislodged. EP scheduled revision surgery for  8/9 and I was sent home. 

Later that day my PM was zapping my heart painfully concurrent with stabbing pain. At 3pm I called EP and informed her of the worsening condition and was told that the BM tech was gone for the day and I would have to wait until tomorrow! I was outraged and demanded immediate attention as this was an emergency not an inconvenience. They finally conceded and I met with the tech at 5pm. He determined that the dislodged RV lead was trying to pace as the RA lead was sensing atrial flutter. He finally disabled the dislodged RV lead which stopped the painful zapping but not the chest pains that were dpendent on body position. Question: Why would they leave the dislodged lead active??

I lived with the stabbing pains with pain pills and finding positions to prevent them. On 8/9 I went to hospital for revision surgery. Since I stopped pain meds the night before the stabbing pains were intense while prepping for surgery. After the surgery the PM was working properly and the stabbing pains were gone and have not returned! While EP would not confirm that lead positioning was the cause of the stabbing pains, she did say it was repsitioned to a different locarion. 

I would love to hear from other PM recipients that may have experienced similar trauma and advise anyone currently experiencing sharp stabbing pains in chest to suspect lead positioning which needs to be immediately corrected

4 Comments

Diaphramatic Pacing

by Grateful Heart - 2016-08-17 14:40:11

Sorry no one answered you.  I'll take a stab at it (pun intended).

The RV lead dislodged and was pacing your diaphram.....extemely uncomfortable and scary if you don't know what's happening at the time.  (That was me about 6 years ago).

For those of us that also have a defib, they keep the RV lead active because the RV lead also contains the defibrillator wire.  So even though it's not in it's correct place, the powerful jolt will still shock the heart if needed. I'm not sure if the same thinking applies to the RV lead when pacing the heart only....meaning no defib.  In either case it is not dangerous....just very, very uncomfortable/ painful.  I had to wait more than a month before mine was finally corrected.  Not because they wanted me to endure it for that long but due to hospital/ insurance conflicts at the time.      

I hope I've been helpful and you're on the mend.  BTW, get rid of the sling.  You don't want to develop "frozen shoulder"

Grateful Heart

UPDATE!

by Bob March - 2016-08-17 20:05:33

Thanks for reply Grateful Heart! 

The stabbing pains continued unabated after they disabled the RV lead. I had my lead revision surgery on 8/9 and had the pain right up to then. Revision was done with twilight, not general and when I awoke the pains were gone! While my EP would not confirm it was a result of lead placement  (or misplacement) she did say that they implanted it in a different location. Based on the coincidental elimination of the pain I have to believe it was a result of how the lead was dressed in the ventricle, possibly wrong or insufficient loop which caused the dislodging in the first place. She did say that it was a micro-dislodge as it was just pulled back from the wall, not completey loose.

I am just so happy to be pain-free! (At least from that pain.)

I too have pain in the chest

by Queen50 - 2018-04-15 08:03:14

I'm 6 weeks post pace maker implant March 5, 2018and have been to the er twice. I have pain in my chest and an X-ray showed that the top lead has changed in orientation. When I went to my pace clinic the nurse  said that the top lead is acting funny. Last night the er dr said this shouldn’t cause the pain I’m in. I just want the pain to stop. I am beginning to feel like no one believes me. Er doctors both have said that they do not know what it is. My cardiologist is on mat leave so I’ve asked for another one. My ep wanted to follow me since my ablation complication was the reason for my pace maker instillation and I was one of the .05%  of the population with that risk. I have no pain around the implant area just in my chest.

Pain After PM Implant

by Bob March - 2018-04-15 14:37:58

Sounds similar! ER doc told me the same thing. I guess we should ask them if they ever had a pm implanted!  There is nothing "funny" about lead failure. After 6 weeks the leads should have secured with scar tissue. The pm tech takes voltage and current measurements to determine the contact bond of the leads. If after 6 weeks the measurements are "funny" (unstable?), you may need lead revision. I would be very disappointed if my  EP Doc didn't insist on it.  Unfortunately, it starts the healing process over again. On the plus side, no one more stabbing pain since my revision

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