PACEMAKER REMOVAL

This is really a Q&A discussion for you and your EP doc

by crustyg - 2020-04-14 06:43:30

Centres that do a lot of cardiac lead extractions can do the job reliably and safely, but there are still some small risks.  If I understand correctly, the key equipment that they use is a special catheter that fits over each lead in turn, and has a ring of low-power lasers at the tip.  They use these to cut the fibrous tissue that will have built up where the lead enters the heart muscle.  Prior to this, the active fixation at the tip of each lead (a little metal helix) will have been unscrewed from the heart muscle, done at the PM end.

Every time your skin is cut open, especially when the wound goes below the outer layer, there is a risk of infection and some bugs are very difficult to eradicate if they can attach themselves to a foreign body.  So removing the PM box and leaving the leads is not entirely risk free.

Should you have the leads removed?  Every time you brush your teeth there is a very brief shower of bacteria in your blood (a bacteraemia) but they aren't growing and are soon killed by your immune system.  Bugs growing in your blood stream is septicaemia.  Trouble is, there is a very, very small risk that these bugs can attach themselves to your pacing leads and then you're in trouble.  How small a risk? Ask yourself how often you hear of an established paced patient getting infected leads.  Hardly ever.  But it's not zero.  That's why patients with mechanical heart valves are given a big dose of antibiotics before a tooth extraction - to cover this nearly theoretical risk.  Bits of metal in joints are less exposed to this bacteraemia, foreign bodies in the blood stream are more of an issue.

Your leads aren't going to snap in half with age and suddenly produce a sharp spike that punctures something important, so you could have the whole setup left in place, and just turned off.

So, some tiny risks of leaving everything in place, a slightly larger risk of removing both leads and the PM box - depends a *lot* on the experience, skill and care of who does this.  Do *NOT* have leads extracted by a centre that does 3 a year.

It's probably going to come down to how you *feel* about having this device in your body that is no longer necessary (and which was probably unwanted).  Yes, not having it will make getting an MRI scan easier in the future, but I suspect that it's more about regaining full control of, and autonomy over, your body.  It's a common enough emotion, and just as valid for all that.

Me, I would leave well alone, but I'm a young senior.

Ignore me, have a *long* chat with your EP doc, get the facts and figures and have a long think about this.

what to do

by Tracey_E - 2020-04-14 10:58:21

Me? I'd leave well enough alone. Lead removal isn't a dangerous surgery but it's not without risk. Leaving it in is fairly low risk. Unless it bothers you, I'd leave it alone. 

Are you 100% sure it hasn't paced at all? Because it's possible you only needed it to pace for a few seconds at a time, which statistically will show up as 0, but in reality those few seconds that don't show up could keep you from passing out. Just something to think about before you have it removed. 

As crusty said, if you have it removed, find a surgeon who does a lot of them, preferably 100 or more per year. If you decide to have it removed, sooner is better than later. I don't mean you have to make a decision this week, but 5  or 10 years from now would be more complicated than it is in the next year or so. OTOH, technology will be a lot better so by then it may be nothing to remove it. I have one bad lead that is capped off, it was put in in 1994. My other original lead is still working plus I have the new one that replaced the bad one. When one of these goes, they will all have to come out to make room for new leads. I know it's in my future so that means I keep an eye on this technology. Ten years ago it was high risk, 5 years ago it was a lot better and there were more experienced surgeons. Now it's still to be taken seriously but no longer considered overly risky and it's not hard to find a very experienced surgeon.  

People leave metal in indefinitely all the time. Think anyone who has had a broken bone or joint replacement.  

One more thing to think about

by AgentX86 - 2020-04-14 13:20:55

If your pacemaker and leads are "MRI safe", removing the generator and leaving the leads in place may leave you MRI "unsafe".

PM removal

by DMJ - 2020-04-20 00:43:57

So I assume your doctor told you you no longer need the PM?  I think if it doesn't bother you, just turn it off, or really find out if you are 100% free of any pacing.  You didn't say if you were a man or women, I would assume a women since you are concerned about your children.  We have more problems hiding our PM with clothes and bathing suits etc.  I would love to have mine gone. Yet, you will be left with a scar and a pocket, I wonder if that will sink in?  You need to really sit down with several doctors and discuss this.  I had leads removed due to my Sarcoid infecting them, yet I went to one of the best in the World, Dr. Epstein at Brigham and Womens in Boston.  So take your time and make your decsion.

Thank you 🙏

by CanadaCourt - 2020-10-29 22:20:51

I just wanted to say thank you to everyone who responded to my original post. I successfully had my pacemaker removed fully in June 16th this year in Toronto at the Peter Munk Cardiac Center. It was a scary process but the pacemaker came out fairly easily after 2.5 years. No invasive procedures like laser were needed to remove the wires. Just a small stint to help pull them out. Recovery was much easier than getting it put in and since having it removed I haven't had any syncope episodes so I'm feeling very thankful!! I appreciate this group and all the support. Thank you!!