Lead Revision

My first PM implant on 5/13 had to be revised on 5/20 because of right atrial lead displacement that started becoming evident three days after surgery. For the second go-round, the surgeon said he was able to relocate the lead a bit higher in the atrium, avoiding suspected scar tissue from my CABG of 2007.

So far, so good. Back to work now, scrupulously wearing a sling during waking hours and an elaborate velcro belt rig at night (look like a sumo wrestler with it).

When can I feel "out of the woods" regarding a possible second displacement? I'm hypervigilant for any little sensation in my upper abdomen that might signal another bout of diaphragm pacing. Enduring three worsening days of that before revision surgery has left me paranoid.

Thanks in advance for any shared insight.

3 Comments

Immobilizing arm not really good idea

by Gotrhythm - 2019-05-27 16:39:27

Please read the "Intense arm pain" post about 3 posts below yours.

I understand your desire not to dislodge a lead, but the pacemaker is put in so that it can move with you as you move your shoulder and arm. Sometimes you have to immobilize a joint, but there is price to be paid any time you do.

Any joint you don't move will become stiff and painful.So don't go overboard in restricting all movement of your shoulder and arm. Check with your doctor of course, but slow and gentle exercises to raise your arm to shoulder height to the front and to the side shouldn't dislodge the lead.

As for how long you must wait before the lead is scarred into place, I don't know. I expect it depends on your body. I do know that scar tissue begins to form immediately, and scar tissue is much tougher than ordinary tissue. There will come a point when virtually nothing will pull the lead out.

There is evidence that most of the time when leads dislodge, the problem is that they weren't in a good place to start with--as your surgeon surmised. So follow your doctor's orders of course, but don't exceed them. And don't try to totally immobilize your arm for weeks.

 

slings`

by Tracey_E - 2019-05-27 17:03:17

Ditto everything GotRhythm said. Wearing a sling after a few days is just asking for trouble with your shoulder. After the first 24-48 hours, if a lead dislodges it's usually because it wasn't in a good place, not because of anything we did. 

Thanks For Replies

by CatDad - 2019-05-27 17:35:03

I do have a fair amount of arm movement with the lightweight sling on; it's mostly a reminder during waking hours to limit arm movement to below the shoulder.

The night-time immobilizer is really necessary for me right now as I use a CPAP, must sleep on my back, and have habitually awakened with both arms over my head, enjoying a good stretch of my back. That happened a few times post-op before I became adept at adjusting the immobilizer.

Now that I'm a week past revision surgery I'll probably stop using the sling. I think I'll keep up with the night-time immobilizing until my appt. with the pacemaker clinic on 6/3.

Your replies have encouraged me to think that I may already have come through the critical period for lead stabilization. Thanks!

 

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I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.