Pacemaker and lead extraction

Yes, I have had my lead into the right ventricular extracted

by parmeterr - 2017-05-14 22:40:59

Did it because the pacemaker was changed from a dual chamber to a bi-ventricular.  I was under general anesthesia and when he tried to extract the lead I could still feel the pulling on the heart.  A weird experience.  He could not get it out so he cut it off and capped the lead with a silicon cap.

Richard

Lead extraction

by peanutdeanna - 2017-05-14 22:50:34

How long ago did you have yours done ?They are going to use laser for mine. 

Procedure

by Artist - 2017-05-15 01:19:44

I wonder why they just don't take the PM out and leave the leads in place to see if that helps resolve your problem.  Lead extraction is pretty safe now, but definitely a more complex procedure than just a simple PM removal.  Then if you should need a PM at a later date it would be a really simple procedure to implant another PM.  If just removing the PM doesn't help they could then consider removing  the leads.  Just a thought.

Lead extraction

by peanutdeanna - 2017-05-15 01:43:29

The reason is because he says the leads he believes are what the problem is. my circulation is not great through my left arm, I have thrombosis and my left thumb turns blue at times. I am going to call another dr I have been seeing tomorrow and see what she thinks.  She is an arrhythmia electrophysiololgist that I really like. It is just really hard to see her because she is really busy. 

more questions

by Tracey_E - 2017-05-15 09:28:18

Why did you get it originally? If it's for something like SSS or av block, 2% is small. If you got it for pauses, 2% is significant because it only works for a few beats at a time. Statistically it may be small, but those few beats are huge. Did they discuss turning it off for a few months first before making the final decisoiin to take it out? If not, that's what I would ask. 

Have you had a venogram or other test to check circulation? I'd want to be 100% sure the leads are causing the problem before making the decision to remove them. It's not the high risk procedure it was even a few years ago, but it is still to be taken seriously. As Robin said, you want someone highly experienced doing the extraction, preferably 100+ per year. 

Extraction

by peanutdeanna - 2017-05-15 20:58:19

I got it for 6 second pauses. I have sick sinus node. I am going Monday to get a second opinion. In my heart I feel like the leads are the problem. This did not start happening until after I got pacemaker. They said they could move it or replace the pacemaker. The EP is saying he believes it is something causing my lymph system to cut off circulation. I have had 5 CTs gone with iodine. 2 sonograms of my arm, a nerve test, and 3 chest X-rays and a mammogram. They all came back good. The dr is saying they are missing something because my arm is swollen and my thumb turns blue and I am in pain. Not sure what to do. I just cannot live with this pain in my arm and chest. 

lead extraction

by islandgirl - 2017-05-15 22:18:02

If they leave loose leads, that negates an MRI, even if the leads are MRI compatible.  I found that out from my EP when I switched from a pm to an ICD and they had to replace the ventricular lead.  I had my pm about 2 years before the lead extraction.  My chest was sore/bruised feeling for a couple of weeks afterwards.  He used a laser and he said it added about an hour for the upgrade.

pauses

by Tracey_E - 2017-05-15 22:39:06

If you were having pauses, then the pacer is only kicking in a few seconds at a time.

60 beats a minute x 60 minutes in an hour x 24 hours in  a day is 86,000 beats. 2% is 1700 beats. At 6 seconds each, that would be 288 episodes a day. Odds are it's pacing more than 6 seconds at a time so it's not that many episodes, but my point is 2% sounds small but the way you use it, it can be significant. 

I'd be more interested in finding out why it's causing problems than rushing to take it out, jmho. Is there a more specialized clinic they could send you to for evaluation, maybe someone vascular? Obviously something is wrong and something needs to be done, but an involved surgery that may leave you with new problems isn't necessarily the answer. I'm no doctor so take  my opinions with a grain of salt, just telling you what I would be thinking about in your shoes. 

Extraction

by peanutdeanna - 2017-05-16 00:18:00

tracye.,  thank you so much for your input.  I agree with you. I have been to a vascular surgeon. He thinks the same. I need to take the pacemaker out.     

I have Also been to a spine dr to make sure it was not coming from my neck and after having a  mylogram he said my spine and neck was good and suggested Chronic Regional Pain Syndrome.  I have been to so many different doctors  

hopefully when I go to the EP for a second opinion I will know more.  

MRI

by BillH - 2017-05-16 21:12:29

"If they leave loose leads, that negates an MRI, even if the leads are MRI compatible."

That is not true. Recent studies have indicate that there was no problem with abandoned leads, even old ones, during an MRI.

However, there are many places that won't even do an MRI on people with completely compatibile equipement and even less that will try with anything "different"

Still need a pacer tho?

by JoJo B - 2017-05-18 12:43:20

Hi, I sure hope your pacer removal procedure uncovers the cause(s) for your troubles and all is resolved, heals well, etc.  Just curious tho, if it were me, I'd be insisting on strong clarity of the needs for your pacer to begin with, comparing then with now, so that if you still need one, perhaps that can also be addressed at the same time or considered for a timely followup procedure... Especially if the initial pm procedure (as opposed to an unrelated issue) caused some type of nerve damage or other problems, then perhaps a different type or placement/location can resolve the problem and also keep you safely paced. There are creative yet common solutions in that regard. At least to be prepared, not surprised... And with very skilled, experienced specialists to ensure everything is planned and performed as expertly as possible. I'd also want to review notes, reports, findings, recos, etc that have been accumulating along the way. Just my curiosity.

Best wishes for great relief and healing!  Hope to hear back on how it all works out for you.

Lead extraction

by peanutdeanna - 2017-05-18 13:00:25

Thank you JoJo. I am going Monday again for another EP to look at my pacing and see what her opinion is. I have seen this dr. Before and trust her. 

Time to Call in an Engineer!

by donr - 2017-05-20 10:04:13

And I'm it!  I AM An electrical engineer but this problem is NOT electrcal - it is mechanical, so I will troube-shoot it in  that manner, just like I did my #1 daughter's front lawn irrigation system, that had the same problem - intermittant thrombosis.  Just because your problem is in a human body does NOT mean that it does NOT obey the laws of physics, & all the rest that apply to non-living systems.

Facts first (In the order they have been developed):

1)  My left arm has lymphedema and has chronic pain.

1a)  I have only used it 2% and it would be ok to take it out. 

2)  I am scheduled to have it out June 7th.

3)   Lead extraction is pretty safe now, but definitely a more complex procedure than just a simple PM removal.

4)   My circulation is not great through my left arm, I have thrombosis and my left thumb turns blue at times.

5)  If it's for something like SSS or av block, 2% is small. If you got it for pauses, 2% is significant because it only works for a few beats at a time. Statistically it may be small, but those few beats are huge.

6)  It's not the high risk procedure it was even a few years ago, but it is still to be taken seriously.

7)  I got it for 6 second pauses. I have sick sinus node.

8)  This did not start happening until after I got pacemaker.

9)  I have had 5 CTs gone with iodine. 2 sonograms of my arm, a nerve test, and 3 chest X-rays and a mammogram. They all came back good.

10)  The dr is saying they are missing something because my arm is swollen and my thumb turns blue and I am in pain.

11)  60 beats a minute x 60 minutes in an hour x 24 hours in  a day is 86,000 beats. 2% is 1700 beats. At 6 seconds each, that would be 288 episodes a day. Odds are it's pacing more than 6 seconds at a time so it's not that many episodes, but my point is 2% sounds small but the way you use it, it can be significant.

12)  An involved surgery that may leave you with new problems isn't necessarily the answer.

Discussion:

1)  Lymphedema:  Go to Dr. Google & read this entry: 

www.webmd.com/a-to-z-guides/tc/lymphedema-topic-overview  Lymphedema is a collection of fluid that causes swelling (edema) in the arms and legs. ... One of the causes of lymphedema is surgery to remove lymph nodes , usually during cancer treatment. ... Without normal lymph drainage, fluid can build up in the affected arm or leg, and lymphedema .  You did NOT mention treating the primary symptom - swelling - & zero attempts to treat it by conservative methods; namely constrictive appliances & you are jumping to SURGERY immediately. But WHY does trhe thumb turn blue? 

2) Tracey is correct - it would NOT be OK to take it out.  There is a WHOPPING difference betweeen Bradycardia (slow HR) SSS, the most common variety & what most people think of when diagnosed w/ SSS, & PAUSES.  In Brady, the beats are still there - in pauses, there is NOTHING there for 6 seconds!  You did NOT specify if that 6 seconds was a MAX pause or a typical pause.  BIG difference.  It's also a small leap from 6 to 20 seconds.  One is a nuisence, the other potential death.  I disagree w/ Tracey on two points.  Each & every beat is a separate episode, so there are actually 1700 times per day when the PM takes over.  Next, your HR actually runs about 80-90 BPM when you are awake.  60 is only a RESTING rate, which you do not attain unless you are very, very still - & you can easily reach it while asleep, just have a dream!  So lets throw in another 900 beats in the day to cover that - You are now up to about 2600 times per day when your PM takes over.  To keep the math simple, we will break those 2600 down into about 450 groups of 6 beats.  That's about 450 times per day when you could face potential disaster!  Hmmmm - that's about EIGHTEEN times per hour.  The average Infantryman in combat doesn't face those odds of getting killed!

3)  7 June is too soon - try treating the lymphedema first to see if it helps.

4)  Lead extraction mortality rate is in the range of 1-2%.   Doesn't souind high, but would YOU fly on an airplane tht only has a 99-98% chance of making it to your destination?

5)  Thrombosis is a whale of a lot different than edema!!!!!  What do you have?  Thrombosis or edema?  Thrombosis is a clog, edema is NOT in the venous/arterial system, but EXTERNAL to it.   Granted, it may well affect circulation at the extremity of the arm, but what about the other fingers?  Do they ever turn blue?  If not, why not?  Have you tried another solution to edema - raising the arm well above the heart to see if gravity takes the fluid out of the limb & returns circulation to the digits?  Let me advance another explanation - there are all sorts of little one-way valves in the veins returning to the heart have you hade an IV inserted in the left arm/hand, down near the thumb?  Possible a mal-functioning valve that impedes flow back, hence making the thumb turm blue.   Have you had any of those circulation tests while the thumb was blue?  If not, the tests are invalid, since the problems are apparently aperiodic (Fancy term for randomly occurring) 

6)  Back to Daughter's irrigation system - problem turned out to be a small flap of plastic in a joint that closed up when water flowed - & it took a bunch of seconds to close when flow started.  Flap in irrigation system = intermittantly malfunction valve in arm.  Sound reasonable to you?

7)  I'l betcha that you WERE Asymptomatic when all those CT's, sonogram's etc were performed!  If so, they were a waste of your time & money!

 8)  That one Dr. is very priescent - you ARE missing something.  Sounds like a lot of guessing to me.  By a bunch of stumped experts

9)  Get someone to give you a rational, logical analysis of te situatiion, like I have & try to conservatively, experimantally treat it for LESSER diagnoses than something requiring surgery that leaves you at greater risk than you face now.

The best to you in your search for truth!

Donr

Lead extraction

by peanutdeanna - 2017-05-22 17:56:25

I got my second opinion and the other electrophysioligists agrees on me getting the extraction done. I also feel in my heart it is the right thing to do. No one knows their body more than themselves and after all the tests and drs I have been to I feel it all s time to get this out of my body. It is causing chronic pain in my thoracic area. Both drs also say I depend on my pacemaker very little. The thing now is I will just pray this will help.!  Thank you for everyone's input.