Leads

They wear out over time

by crustyg - 2020-05-08 10:14:44

The constant flexing of the leads as your heart beats will sometimes cause a lead to start to fracture (usually the central flexible wire, it's thinner) so they don't conduct reliably. Fracture doesn't mean it snaps in two like a pole-vaulter's pole leaving you with a sharp spike in your heart.  From the outside the lead still appears smooth and perfect.

Sometimes fibrosis at the tip makes the lead progressively less useful, so it has to be replaced.

I think some of the congenital CHB folk here have had one or both leads in for 20+ years, others have had a lead fail after 15years.

It's luck of the draw, but AFAIK many folk with very long-term pacing history have had to have an additional lead or (more commonly now) a lead replacement.

HTH.

lead life

by Tracey_E - 2020-05-08 13:44:08

Average lead life is 15 years, or so I've been told. There are quite a few of us here with leads much older than that. I have one that's 26 years old next week and still going strong, the other was replaced 10 years ago so it had average lead life. My ep does xrays every year to look for minute changes as well as keep an eye on the threshholds on the pacing reports. There is usually plenty of notice when one is starting to go bad. I knew about the other one several years before we did anything about it. It kept on chugging along until it was turned off, they had to crank up the juice to get it to pace so it depleted the battery more quickly, but it never stopped working. 

lead longevity

by Selwyn - 2020-05-08 13:48:09

There is no answer as to how long leads last. It depends on the type, use, and your life style.

Lead technology has changed over the years with better design and materials. This enables the PM to function at an optimum level, to have less lead detachments, and with steroid incorporated in the tip end, and an increase in porosity of the surface to increase the contact with the heart muscle, modern leads are an improvement on old designs.

Personally, I have a slight lead problem - impedence, measured at each check up is increasing. Battery longevity is hard to predict. However, my cardiologist is planning to stay with the slight lead problem as I am not in need of regular venticular pacing, and use the old lead when my next PM is due.  Lead removal if undertaken, is a specilist field ( eg. using laser).

The longer leads have been in place the less chance there is of them being displaced. There is a saying , "If it ain't broken, don't fix it".  Modern leads do offer a slight benefit, however in practice, the old established leads are the winner, unless impedence becomes critical. 

Perhaps people in this Club can establish what the record for lead longevity is ?  

Selwyn

by Gemita - 2020-05-08 14:40:54

Do you know how long the steroid substance remains active on the lead tip and does this steroid substance cause any systemic adverse reaction in the body?  Many thanks

The dexamethasone washes out within a month

by crustyg - 2020-05-08 15:46:27

There are only a few micrograms of dexamethasone in modern leads, just enough to provide local suppression of fibrous tissue growth around the very tip of the lead.  It's all gone within a month.

There's far too little to have systemic effect (although we used to say the same about topical eye steroids, and that proved not to be correct!  Doses in that case are/were much higher - thousands of times).

HTH.

Thank you Crustyg

by Gemita - 2020-05-08 15:55:01

that is somewhat reassuring !!  

33 years

by dwelch - 2020-05-23 06:38:04

I have four leads am using three of them.  One is from 1987 (a broken one from 1987, think the doc broke it during the first replacement), one from 1994 and the other from just a few years ago.  All are working well and lucky that all fit in the one side.  When I started this journey removing leads was not a thing.  Now it is.  

This is in part why we have the tests that we have when we go to the office, they have a test for each lead to see that it is functioning which implies not broken.

Hmm, May 11 1987 33 years a week and a bit ago...

Im one of the CCHB patients crustyg was talking about.

The ones I am using are three different brands, and I have had had medtronic, st jude and boston scientific pacers.

If you are at 24 years you are not far behind Tracey_E and myself.  If the leads are still working they will keep using them.