Abdominal Pacemakers, pregnancies and water births......oh my?

Hi!!

Noob and former message board lurker here! I've found a few posts about pregnancy and pacemakers but not quite what I was looking for. I have 3 questions and any opinions would be great. I had a plan to discuss with my doctor but given the current situation with the coronavirus my appt has been postponed to TBD...and I'm super curious about getting SOME idea of people's experiences. Ok, background: I have full heart block and am 100% pacemaker dependent. I had the first placed within the first months of my life. For whatever reason I always had a choice about where to put it. I'm assuming since I was a super naturally skinny girl until college (when i got to a thin but normal size...yay curves!) I always kept my abdominal pacemaker. So upon my last device change ~7 years ago I had my doctor go "wait...how old are you? Oh you're pregnancy age, let's move it!" and I freaked out a bit (ok, a lot...it was literally sprung on me lol) and said no. They agreed but cautioned me that if my pregnancy sized belly "unplugs" my pacemaker then they'll have to shut off the abdominal one, place the shoulder one and then the abdominal one would basically be left forever....yikes! They didnt give me any odds of that happening but at the same time they didnt seem SUPER pushy as if it was a high risk. So fast forward 6 or so years. I'm 32 going on 33 and I have a few questions:

1. Has anyone ever been pregnant with an abdominal pacemaker? I'm scheduled for a generator change in the next year. 

2. Has anyone had a water birth with a pacemaker or similar device regardless of if its abdominal or shoulder placed?

3. What's been your experience with digoxin and atenolol while pregnant? 

Sorry if this is super long!

Edit: yikesss I have a 4th question: do you see the shoulder pacemaker as a lump under your skin?

 


11 Comments

PM placement

by ar_vin - 2020-04-10 03:11:03

Lots of good questions to which I have no answers - sorry!

But, I can speak to your concern about PM placement ("shoulder"). 

I'd suggest you discuss having the PM placed under the left pectoral muscle; not at all prominent. This is pretty commonly done and I requested such a placement when I got mine implanted. I'm quite thin so it's still visible as a slight bump on my left upper bare chest.

I'm sure female PM recipient members will chime in about their experience and suggestions about PM placement.

Make sure you discuss this with your EP well before you schedule surgery.

 

Pacemaker placement & Pregnancy

by Selwyn - 2020-04-10 07:34:11

Being male, I have no personal experience! ( I did hospital obstetrics  at one time).

The problems of PMs in pregnancy  are related to site and pacing.

Site:

With increase breast growth/abdomen girth the skin may be stretched . The best site for a PM in pregnancy is below the chest wall muscle or within the muscle.  The box may otherwise stretch the skin and cause erosion, with an open wound, this is undesirable.

Pacing:

There are increased cardiac output demands of pregancy. The base resting rate of the PM  may need to be adjusted upwards to avoid shortness of breath as the pregnancy advances.

Lead displacement may be a problem if the leads are stretched with abdominal placement. This depends on how the leads lie in relation to the womb+its growth.  The advice you have been given is probably the best. The chances of this happening cannot be calculated, however if you wanted to avoid the above complications some pre pregnancy cardiology planning is required.

pacing while pregnant

by Tracey_E - 2020-04-10 11:24:01

I'm on my 5th. First 4 were under the breast so no lump whatsoever. I had two pregnancies when it was there, no problems. My newest, #5, is under the pectoral. I'm past the age of babies but it would be even more out of the way now than it was when it was submammary.  Last thing you'd want during pregnancy is complications and emergency surgery because leads got detached. Personally, I wouldn't want the chance of that hanging over my head so I would probably go ahead and move it. 

It can be done so that there is no lump. Make sure your doctor knows up front that it's important to you. I was really underweight when I got my first one. My cardiologist brought in a plastic surgeon to do the placemen,t and bony as I was they were able to hide it nicely. Alternate placements are more common so that might be overkill now, but a lot of ep's are only concerned with the heart and not as interested in how it looks. My doctor decided to let someone who specializes in that deal with it. Better for me, one less headache for my ep, easiest job of the day for the plastic surgeon. Win/win. 

The only thing I have wrong is av block, which is fixed by the pacer, so my cardiologist told my ob to treat me like any other healthy mom to be. They had a phone call, before that the ob was ready to send me to a high risk specialist and was talking about neonatal cardiologists. My cardio said none of that was necessary. What we have is not genetic so there's no need for additional monitoring of the baby. If you want to look into water birth, I don't see why you couldn't. I had my babies in birthing suites rather than the main hospital. I was kind of surprised both doctors were ok with it but they were. They had me on a cardiac monitor during labor, just in case. My heart was fine, mostly that just meant a lot of people poking their heads in my door because they aren't used to seeing pacing spikes on their monitors lol. 

Pacemaker dependent

by AgentX86 - 2020-04-10 14:09:12

If you're pacemaker dependent you don't want to take any unnecessary chances that your PM will fail. It wouldn't be good. I'd say move it.

Either under the skin or pec is a personal choice. Very small/skinny people or for vanity reasons  under the muscle is probably a better choice but will be more painful and take longer to heal.

 

PM placement

by ar_vin - 2020-04-10 15:05:30

"Very small/skinny people or for vanity reasons  under the muscle is probably a better choice but will be more painful and take longer to heal."

As usual the usual suspect delivers hot air.....

It's not about "vanity reasons"! Except for you know who......LOL

For some one who is physically active (rock climbing, backpacking, etc etc), under pectoral placement offers a bit of cushioining - I speak from personal experience......

As far as longer to heal.....baloney....maybe a day or two as long as the surgery is performed by a competent EP and you're careful during recovery. Again I speak from personal experience.....

Best to consult your EP and discuss much prior to surgery.

 

 

 

vanity

by Tracey_E - 2020-04-11 11:45:03

Number one reason why I like mine out of the way is it doesn't bother me when I'm lifting weights, kayaking, strapped in to do a zipline or roller coaster, hiking with a heavy pack. 

Number two reason why I like it out of the way is I'm not likely to damage it doing anything under number one.

Number three reason I like it out of the way is it looks good.  It looks nice, what's wrong with being happy about that? Even if that was my main reason, so what?? I still don't call it vanity.  More like human nature. 

Vanity

by AgentX86 - 2020-04-11 12:42:21

It was a stronger word than I intended but couldn't (still can't) come up with another (single) word that meant "for appearance reasons" that doesn't imply "obsessive".  The bump on my chest doesn't mean a thing, next to the sternotomy scar.  I don't really care about such little (to me) things but others obviously do.  That's all I was trying to say.

If others don't like my word choice and want to escalate with ad-homonyms, so be that too.  It's another "facebook" trait.   I can handle it (but not facebook ;-).

Thanks!

by AshG - 2020-04-11 15:30:06

Thanks so much everybody!! I really appreciate everybody weighing in! If there's anybody else with advice, keep the posts coming :-)

Pacemaker placement

by Dave H - 2020-04-11 17:16:10

Couple three EP's I've dealt with have left any notion of "surgery" to a surgeon.  They've dealt only with under the skin placement.  At my latest PM change, EP didn't see need for me to even stop warfarin use.

Under muscle

by TTT34 - 2020-04-27 09:08:52

Hi I too am young with a PM (37). I also was born with a complete heart block. Did your mother have lupus? Anyhow I’ve had my PM 2 years. I am quite thin so my doctor put the battery under the muscle so you can’t see it. It was bit more painful for a few weeks as it does upset the muscles around it but totally worth it. You can’t even see it and there is only a small scar. :)

Under muscle

by AshG - 2020-04-27 12:28:52

Nope. No lupus in my family. I was also genetically tested and my heart condition isn't genetic. Just luck, I guess. 

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