A Frayed Lead

So, I have a frayed lead. I'm barely paced, like way less than 1% of the time. I've had my pacer for 15 years. I also have a cow valve AVR. I am 52 years old. 

To leave the lead, or remove it? That is the question.

Any experience?

Thanks!


5 Comments

A frayed lead

by Gemita - 2020-10-30 09:08:46

Hello Cyborgmountainhuffer !

Can I assume you have a dual lead pacemaker and that one of your leads is frayed?  Your bio doesn't give much info.  Are you talking about your ventricle lead which is barely pacing, less than 1%?  

Have you had a discussion with your doctors and what was their opinion?  Do they intend to replace the lead (for example, should your heart condition progress in the future, you might need that extra lead)?  Sorry lots of questions, but difficult to answer without knowing a bit of background.

To leave the lead, or remove it?  I believe they can cap a redundant lead and leave it in place without harm.  If they intend to replace it and there is sufficient space in the vein, they can place a new lead beside the redundant one.  Extraction of the frayed lead would carry some risk for complications, especially in unskilled hands, so I would ask my doctors if it would be possible and safe to leave it where it is, or alternatively, to refer you to a specialist centre if you decide to have the lead extracted.  I attach a link which might be helpful to glance through although I realise things have moved on since this was first published

https://www.ajconline.org/article/S0002-9149(15)00632-3/pdf

bad leads

by Tracey_E - 2020-10-30 10:28:09

Is it actually frayed or is the insulation ruptured? If it's seriously frayed they may want to removed it. If it's just ruptured insulation or otherwise just plain not working, they can usually add a new lead and cap off the bad one and leave it in there for now. That's what happened with mine. Some doctors are faster to extract and start fresh than others. Extraction was suggested to me. That was 2010. I figured if I could squeeze another 10-15 years without extracting, then perhaps my next set of leads will be my last. I explained my logic to my doctor and he agreed with me. I'm 54 and been paced 26 years now, my other original lead is still going strong. So far, so good. And while I wait, leads get thinner and stronger, doctors who extract get more and more experienced, the lasers they use to extract get better. That said, extraction is serious but not high risk so if they have a reason to extract now, don't be afraid of it. 

Afraid lead

by AgentX86 - 2020-10-30 15:26:33

Since you're so young, given the choice, I'd go for it now. They've gotten really good at it, though a specialist is still required IMO.  I say now because they don't last forever so you can expect another to fail at some point.  If you added one, you'd have to pull both out if you needed another replacement.  At your age, this is a very likely scenario in your case.

Leaving a capped lead also makes your setup not MRI compliant, though your leads probably aren't anyway.

Your AVR shouldn't have any implications in this surgery.  It's on the other side of the heart so shouldn't be touched at all.

Finally, Some LEADS! :)

by CyborgMountainHuffer - 2020-10-31 02:13:46

Thanks everybody! WOW, what great comments and insights!

Gemita, it never occurred to me that it might be useful in the future. Definitely a consideration! I'll have to ask that question. It is a dual lead, but I don't know what's paced exactly. I'll ask(or look at my stuff).

Tracey_E, great thought about the tech improving! I was worried that it would get more embedded, but I think the tech will probably get much better, too. 

AgentX86, HUGE relief to hear my AVR is irrelvant. I'll check to be sure, but that would be terrific.  

getting embedded

by Tracey_E - 2020-10-31 11:03:05

We are all different with levels of scar tissue. In my case, they are already embedded such that I'll be high risk when they are extracted. More embedded isn't going to make it much worse, but I'm hoping that technology improves enough that getting them out becomes easier so I'm less high risk.  No one has a crystal ball, so who knows.

My main goal was to hold off long enough that my next set will possibly be my last. I'm 54 now with a 26 year old lead, so if that lead makes it until I'm 60, then if my next set lasts as long as this set, that gets me to 90 years old. Of course there's no guarantee the next set will last as long as these have, but I can hope!

I'm not aware of any research on how the veins hold up on a second extraction. I know when they can no longer use the veins on the left, they move to the right or if that doesn't work they can do epicardial (outside of the heart rather than in the vein). Again, not a big deal if that happens but I'd like to avoid it if I can because it's more complicated. I'm just trying to increase my odds of keeping it simple.  

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