3rd lead added?

Hi all! 

I have had two leads for 13 years now, today for the first time a doctor mentioned possibly adding a third lead at some point. So, not replacing, but adding a lead "to the left side". Have many of you had this done, why and how did it go? The doctor seemed to think that three leads would have been better from the start since adding a lead afterwards carries a risk of infection. 




when to add the 3rd lead

by Tracey_E - 2020-11-03 10:09:47

Has your EF (function) dropped? Adding the third lead can help when function drops. Doctors vary, but my doctor is adamant that it not be added until we need it. He said he has not seen evidence that it prevents heart failure, however it can help it once it starts. A very small percentage of doctors think starting with it is the way to go but most start with 2 lead until we need more. Unless your function has dropped, or he's just talking in vague terms about the future, then I would get another opinion before considering it now. 

Every surgery carries a very small infection risk. I don't think that risk changes if the device is upgraded later vs starting with it. Honestly, I'd be a little afraid of a doctor who talks about infection like it's so common. 


by pupu - 2020-11-03 10:44:54

Vague is the right word for the whole visit today. Did not know whether to laugh or cry on my way out of the clinic... Anyway, thanks for the info. I understood that a 3rd lead will be an option in the future, not right now. I was just so surprised, no one had mentioned it before. 

Third lead

by AgentX86 - 2020-11-03 21:08:15

I have no idea how the Finnish healthcare system works but if you can get your records, look for your ejection fraction EF or LVEF.  If this number is falling, it could be why he's discussing a CRT pacemaker. 


by pupu - 2020-11-04 03:01:56

It is easy to get one's own patient records, but often the notes are quite short and do not really explain much. But now that I have slept on it, I believe it was good that he mentioned the possibility so that when/if the time comes, I will have had time to adjust to the thought. My ejection fraction has gone up and down many times over the years, and if I understood correctly it should not be too bad at the moment. Thanks for the suggestion!

Qrs and r waves

by pupu - 2020-11-04 10:29:58

So I looked through my records from the last 5 years and my highest EF was 60% and lowest 37%. Latest was mentioned as 40-50 %. So that is fine, right? New thing in the notes from yesterday was QRS complex 200 ms. Also, I realized that for years now, the notes always say that R waves are not measurable. Any thoughts?


by Tracey_E - 2020-11-04 13:23:29

Ideal EF is 50-70 so you're just a little bit under that. It usually needs to be well under that before they upgrade to CRT. 


by AgentX86 - 2020-11-04 15:47:23

Do you mean that the p-waves aren't measurable? The r-wave is part (the tall positive spike) in the QRS complex and represents the ventricles contracting. The r-wave represents the atria contracting (and the difference being the AV node conduction time).

Yes, R waves

by pupu - 2020-11-04 16:34:24

I checked the records again, and it is R waves. I do not know what that means. Translated from Finnish, they say e.g. "no measurable R", "R cannot be measured", "R wave does not appear", "R -, P 3.9 mV" etc. It cannot be all that serious because thay have never explained it to me and I have been living with it atleast for 5 years. (I cannot see my older records). It would be nice to know if it means anything.

Really weird

by AgentX86 - 2020-11-04 23:54:14

I've never heard of a missing r-wave.  I don't know how you can have a QRS complex without an R-wave.  <https://en.wikipedia.org/wiki/Electrocardiography>

I guess you learn something every day.


by pupu - 2020-11-05 01:59:35

Ok, a little concerned now... But I checked all the notes that I could get my hands on, and it is always R. Once might be a typo, but every time? And checked by several different doctors, a mistake doesn't seem possible. 

Really weird

by AgentX86 - 2020-11-05 21:43:22

I guess such p-wave abnormalities are a real thing.

That's why I like this group.  It motivates me to search out information that I otherwise wouldn't.  I still don't undertand it but it's a thing.

third lead

by dwelch - 2020-11-06 15:16:19

yes I have a third lead, not sure if that matters the thread went another way.

33 years paced this was around year 30 after 15+ depending on factors the heart may not be happy with being paced on one side.  my EF was normally in the mid to lower 40s as it dipped toward 35 is when we did this.  pacer 4 didnt live a full live we put in pacer 5 a biventrical and added this additional lead.  EF came back up, wasnt necessarily expecting that just expecting to stop it dropping is what I was told.

I had belly bumps at first (leads on that side can trigger muscles other than the heart).  I had to stand just right and breath in just right and it would be like one maybe two beats.  If I could have figured out how to make it last longer it would be a nice party trick.  If it happens all the time or when sleeping or whatever call them they will adjust it...it needs to be a strong enough pulse to trigger the heart, but not so much that it triggers other things.  Might never happen.

Interrogation is slightly longer now they have an additional lead test to do.  Strangely I felt something odd on the first ingerrogation test first morning after, but has not happened again.



by pupu - 2020-11-07 03:11:01

Thanks for telling me about the possible side effect. That did not occur to me, although maybe it should have, since I had a terrible time with one of my leads triggering my phrenic nerve. The most horrible week of my life... Glad you benefited from the 3rd lead. 

You know you're wired when...

Your heart beats like a teenager in love.

Member Quotes

Since I got my pacemaker, I don't pass out anymore! That's a blessing in itself.