PM migrating?

I'm completing day 3 post op and I just felt my PM almost in my armpit. I've been in considerable pain. Is it possible it migrated this quickly? Is it possible the EP actually placed it there? No wonder it hurts. When I move my arm it seems to push on it. I didn't notice it there before but maybe there was more swelling and I missed it. I would say it's a couple inches from the incision. I might be seeing and feeling the end where the leads come out. I saw a recent thread on PMs migrating there but they had them awhile.

I haven't lifted that arm above my shoulder, but I do move it. 


Get back to the implanting Doc ASAP

by crustyg - 2020-11-16 06:03:45

I strongly recommend that you get a face-to-face review with the doc who did the implantation as a matter of urgency.  If the anchor stitch has come loose or broken the PM could easily pull one of your leads out.

Don't delay, don't take any nonsense, get back in front of the doc ASAP.

Yes please seek help

by Gemita - 2020-11-16 06:28:52

Yes totally agree with crustyg, you need to be seen urgently.  There seems to have been considerable movement of your device which is not normal at all.  If the leads start to break through the skin this is serious.

My pacemaker has moved slightly towards my armpit and I can feel it too at times but this seems to be normal settlement for me (after 2+ years).

I do hope for the best and please let us know what your doctors say

Update on PM migrating.

by Pharnowa - 2020-11-16 18:43:09

I saw the Device Nurse today and he interrogated. Everyone agrees my PM migrated to just starting under my armpit. He's going to talk to the EP but since the interrogation shows everything is working fine, he thinks nothing should be done.

I hope he's right but I do bump it when I move my arm. He thinks if it goes further, they will have to move it. Since I only found this 13 hours ago, I won't be surprised if it moves more, but I hope not 

The pain stopped and he believes the device may have been resting on a nerve. It's now "soreness" relieved by Tylenol.

Thank you so much Gemita and crustyg for alerting me to the potential seriousness!! ❤️

Mine has migrated as well...

by TraJac71 - 2020-11-16 21:13:49

I have the same issue! Everyone agrees it has migrated (I'm actually with a different cardiologist office now) but they also say as long as my wires are in place, it's fine. Easy for them to say! I'm aware of the damn device with literally every movement I make. My chest is tight and it's freaking annoying!

I see them again tomorrow. It's very frustrating!

It IS annoying, TraJac,71!

by Pharnowa - 2020-11-17 00:30:51

I am coming to see how annoting it really is. I was delighted I didnt have to do anything, and I ddn't want to risk infection, and the awful pain abated,  but every time my arm moves toward my trunk,  it pushes rhe device. That's a strange and sometimes painful feeling. Once it pinched my armpit. And this is all the first 24 hours. This may be woefully ignorant, but I wonder if my lymph nodes will swell. I'm definitely not open to a mammogram right now.

I do hope they listen to you and help you. This definitely limits our fashion choices.🤔

The real issue isn't the migration

by crustyg - 2020-11-18 08:12:59

Hi: Thanks for the update.  From your perspective your PM box location is the #1 issue, but there's a more serious risk.  The anchor stitch doesn't just hold the box in the pocket that they created, it stops the PM from turning over.  Once the box has migrated out of what should have been a snug pocket, there's a risk that it can turn over, and the more that you bump it, the more likely that is to happen - although it's clearly not your fault.

As the PM flips over (*if* it does) it twists the leads (and think of how twisting two pieces of wire together *shortens* them), and this can quickly damage or break one or both leads - they are not designed to take a sustained twisting stress (in fact they are designed to be quite stiff when twisted so that the doc who does the implantation can steer the far end by twisting the box end to put them into place (the atrial appendage is an example)).  Anchor the far end (with most moden leads there's a small metal screw that fixes the lead into heart muscle), especially as the fibrous tissue grows around the point where the lead enters heart tissue, twist the box end and soon you have a cracked or broken lead.

In your shoes I would politely and firmly point out that just because the PM+leads are doing OK now, does not mean that they can ignore this.  Your box needs to be put back into the pocket and stitched down properly.  Polite and firm, and relentless.  Don't let them fob you off.  Get it fixed ASAP.

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