Leaving detached lead in?

Not enough information for sensible comment

by crustyg - 2020-08-08 12:39:14

Assuming that it's the heart end that's detached, I don't think you've provided enough information for sensible comment.

1 It depends on what you mean by 'detached' - unusable due to overly high impedance?  Actually floating around inside your heart but not attached to anything?

2 Which lead - atrial or ventricular? (I think I can guess)

3 What sort of lead - passively fixed or active fixation with the metal helix extended?

In the long run, there's good evidence that ventricular pacing only isn't the best for you.

There are centres (esp in USA) that have a *lot* of expertise in removing internal pacing leads with very good results and safely.  Not entirely risk free, but that's life.

*Assuming* that your atrial lead is now non-functional, but not an active-fixation lead floating around inside your heart, then you can get by for some time like this - months=>years. But it would be better to have the lead extracted and replaced.  Even if getting another lead into your heart might be very difficult due to previous disease/therapy/procedures.

HTH.

Leaving detached lead in?

by Paintsmudge - 2020-08-08 19:46:46

This may not be a lot of information, but I don't have much more. The doctor informed me that I had two leads one in the upper chamber, and one in the lower chamber of my heart. He informed me that the upper lied it's detached from the pacemaker. Because it was not functional anyway, he turned it off.  Then just told me that he feels it is too dangerous to extract it. But I am concerned of what kind of dangers there could be of leaving it there.

I've had 5 lead extractions./replacements

by FirstDuely - 2020-08-08 20:41:37

I prefer to have my leads removed.  Especially when they crack.  And I've had my pocket changed from left side to right side so extraction was best.  So I was very fortunate to get one of the best on the planet for doing this.  I posted this below previously:

I've had 5 leads removed and replaced and now have thicker, 3 layered MRI Safe leads.  Two leads were removed when the doctor decided to move the pacer from left to right side of my chest and last year I had the pacer placed in the muscle.  The leads were too delicate and cracked and started to leak those tiny, little electrons. Batteries don't last long doing that.

My first pacer was a single lead Medtronic, not dual paced placed due to SSS.  That did not work for me.  About that time 34 years ago the Siemans Corporation in Sylmar, CA had developed the first dual chamber pacers in the world.  I got the first one!!!  Talk about being a data point in a grand experiment.  I'm still around folks and plan on riding my road bicycle when I'm 100.

I've had 10 pacers in my life since I was 36.  I'm now 70.  I ride and exercise and travel and enjoy every day of my lucky life with my wife and family.  

The lead extractions were done by Dr. Raymond Schaerf at Providence St. Joseph's Hospital in Burbank, CA.  He was one of the first 6 doctors to start doing extractions.  He's also a chest cutter just in case.  Google search him.  He also now travels all over teaching the technique he has been doing.  My first extraction took 6.5 hours.  The last just 1.5 hours with pacer replaced each time.  My pacer is a St. Jude Medical PM2272 currently.

My recommendation is to find a doctor who can extract the old leads.  Period.

Hope this helps you in some way or another.  Then go about the planet and enjoy life!!!

Gary N.  in Hemet, CA

Leaving detached lead in?

by Paintsmudge - 2020-08-08 20:51:04

Gary N --thank you so much for your input. I very much appreciate hearing of your experience. 

leaving it in

by Tracey_E - 2020-08-09 09:52:22

I did the opposite of Gary. I chose to leave the bad lead in and add because there was space in the vein to add the new one. The old lead has been capped off and just sitting there since 2010, no issues. My other original lead (from 1994) is still working.  I am hoping that my next set of leads is my last so that by putting off extraction I can get away with only doing it once. I'm 53 now.

I don't understand why a 3 year old lead would be risky to remove. That's pretty young for a lead. It's a specialized surgery and you might have to travel to find an expert in it, but there are quite a few of them out there. 

That said, I second crusty's questions. 

Thanks for extra info

by crustyg - 2020-08-09 12:06:14

If I understand the additional information that you've provided (thanks), the atrial lead was non functional and has now become detached from the PM.

I'd be surprised at that: there's a locking screw that is designed to make this impossible once the lead has been attached to the PM and even a little disposable torque wrench tool that should be used to tighten this locking screw (otherwise at PM change it may be impossible to remove the lead from the PM without damaging the lead).

I'm going to be blunt: it's time to find a better EP doc.  *IF* I've understood your present pacing setup correctly - and that's a big *if* - this is not acceptable.  You need to have two working leads (unless you're in established AF) and it's a really bad idea to have the PM end of a lead floating around in your pocket.  I think there's a significant risk of it coming through the skin and then you'll be in a world of trouble.

I expect I've misunderstood, but if I haven't, re-read some of the other comments and start finding a new/better EP doc.

Best wishes.

oh!

by Tracey_E - 2020-08-10 09:41:56

If it's disconnected at the box I take back my reply! That was for a lead gone bad. If it's not working or in a position where it's not pacing that is totally different from disconnected. 

few things

by dwelch - 2020-08-11 14:56:02

first I agree with some others that if it is detached on the pacer end, then 1) how does the doc know where it detached.  2) why was it in there if you didnt really need it 3) how did it come detatched, someone failed to do their job if that is what happened 4) if that really happened they can "simply" reattach it no need for removal. 5) if it is broken elsewhere and the insulation has failed then you would probably have some muscle inside if you firing off with the pacer (if it is pacing) 6) if it came loose in the heart end you very likely dont want that flopping about with a sharp metal tip on it.

I have a 33 year old lead that failed 26 years ago (well doc broke it during my first replacement) back then you didnt remove them not easily.  I now have four leads am using three, no real desire to remove any unless necessary. 

It is time to find a new/better doctor.  This one either is not explaining things to you properly, or has failed in more than one way to do their job.  The doctors feelings are not your concern, your health is.  Start calling around, time to find another.