CRT device in the abdominal area, is it really that bad of an idea?

History: CHB, 100 percent pacer dependent, current device is Medtronic dual chamber atrial sensed.  New diagnosis of paroxysms of SVT and other arrhythmias, EF somewhere between 35-40 percent, moderate to sever mitral regurgitation, bioprosthetic tricuspid.

Upcoming surgeries procedures: Mitral valve repair or replace (repeat sternocotomy), addition of left ventricular lead and swapping out the current device for crt device, ablation after for SVT and arrhythmias.

So I have received various answers depending on which doctor I talk too about this:

My current device is in an abdominal pocket (so was my first device).  I personally like it there because it is out of the way both cosmetically and physically (no bumping or rubbing etc), my EP tried to convince me it would be better to have the new device placed on my chest because the leads won't need to be as long and less chance of them cracking etc.  this would mean a third procedure vs placement during open heart.  She eventually agreed to sign off to have it placed in the current pocket but she really did not like the idea, the surgeon and HF doc said it would be fine in my abdomen.  Have I made a poor choice not moving the device?  To me it makes sense to have less procedures because there would also be the removal of current device and leads, if they can simply add a one more lead and place it in existing pocket that makes more logical sense to me.  Anybody have expierience with this? Btw surgery is scheduled for November 11th so not far off.

3 Comments

My thoughts

by Gemita - 2020-11-01 06:30:26

I have to say Asully, this is a difficult one to answer, especially as you are getting so many different opinions from different doctors.  Would you care to share with us some of the opinions/advice you have been given?   This would be very interesting and might help others who find themselves in a similar position in the future.

The only doctor’s opinion that really matters of course is the one responsible for your CRT device care and it looks as though you clearly do not have the blessing of your current EP.   If she is not convinced or confident that you have made the right decision, then this would alarm me and make me want to find a new EP who supports my decision. 

Are you able to find a new EP, perhaps in the same hospital, who could take over your device care and who would be confident to go ahead with abdominal implantation as you would wish?  I feel it is vital to have the backing of your EP and to have confidence in your EP which doesn't appear to be the case?   A lot of what you say makes complete sense to me too as a device patient, but I do not have the knowledge or experience of your current EP who clearly believes that the chest area would be the better position.

You need to feel secure and confident with any decision you make as you move forward and not to allow doubt to creep in.  You seem to have received lots of different opinions.  I would go with an EP who is confident that placing a new CRT device in the same abdominal position is both sensible and the best choice for you, an EP who has a lot of experience with abdominal CRT pacemaker placement in adults. 

I wish you well Asully and hope that all your procedures go well and you remain safe.

if it aint broke

by dwelch - 2020-11-02 11:09:51

You are going to get a lot of opinions, and the reality is I dont think there is a "right" answer.

I would say though if it aint broke dont fix it.  If the leads in the current pocket are not broken and everything is working then dont move it.  Now understandable if the upcoming procedures provide a better option for removing existing leads than a normal lead procedure.  Or just leave the old leads in you are not sharing a vein with the chest leads....if it aint broke dont fix it...

Got blessing from ep, cardiothorcic surgeon placed device

by asully - 2020-11-23 00:07:16

My ep was on vacation when I had it done so my thoracic surgeon doing the MVR placed it in my abdomen he used same pocket but made a new incision, also had him suture it in place so it won't migrate again.  I am happy with the result as it saved me from another procedure however the thing is huge!  I don't recall either of my last two devices protruding so much, praying it's just extra swelling.

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