Atrium lead

Had my 4th box change yesterday on my dual PM, when I was in the recovery room I passed out 5 times, the Dr came out of theater to see me, the pacing team said I have. Noise on my Atrium lead ans is causing my ventricle to become confused so it won't pace, this is serious as I am 100 dependant. The Dr has turned off the atrium lead and they have reprogrammed my PM in DDD mode (I don't understand what this is) Dr says I should be OK with just the ventricular lead as pm was fitted due to low heart beat  leading to blackouts. Nurse asked if I could have someone with me for the next two weeks just to be on the safe side, I have now come home and feeling very scared and confused I don't understand what is happening,I had just come around after a general so wasn't in a fit state to ask questionsi have had 2 leads for 23years and now only one will i be OK Dr gone on holiday for two weeks so not around to speak to me. I have a pacing app in two weeks. I am so anxious, scared and in pain as it was put under muscle. 


1 Comments

Not a great experience

by crustyg - 2020-07-02 04:11:01

Hi Maureen: My sympathies, this isn't a great experience and the problem that you've run into hasn't been handled well.

It sounds as though your atrial lead has developed a fault - although the timing of this and the replacement of your PM box suggests that there's a causal link between the two.  Whether this is an electrical issue between your old lead and the contact in your new PM (there have been some difficulties with leads made by one vendor used with a PM box from another - shouldn't happen but it has in the past), or whether the lead was twisted and flexed just a bit too much at box replacement is probably unknowable.

It sounds as though you are going to end up needing that atrial lead to be replaced, but before that becomes certain they need to check impedances and sensing voltages when it's a bit more calm and collected.

There's an international standard for pacing modes: DDDx means Dual-chamber paced (first D), Dual-chamber sensed (2nd D), Dual-chamber response to sensing (3rd D) and the last character O or R indicates no rate modulation or Rate Responsive.  Clearly, if your atrial lead has been switched off you are NOT in DDDx, but actually VVI.  Depending on your underlying condition you want to get out of VVI ASAP, as it's been shown to be less good than other pacing modes over the long term.  But it should stop you from having blackouts until you can get back in front of your EP doc (who is probably having a well-earned rest from the Covid-19 experience.  Lots of docs and nurses who deliberately chose not to look after the sickest patients - quite a few of whom die - were pulled back into ward-based practice looking after seriously ill Covid-19 patients with all of the emotional burdens that brings).

Having the PM put under your pectoral muscle definitely hurts more than under the skin (so other contributors here have pointed out).  This can be because a) you asked for it - less visible for the ladies, or b) because the original PM pocket has so much fibrous scar tissue that it's difficult to get the new PM into it - or it's way too big and the PM will slide around and break the anchor stitch.

You should be fine with your current pacing mode for a few weeks, but make sure that you get an urgent appointment to see your EP doc in a few weeks - there's a lot to check and discuss.

Best wishes.

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