Removal of unused pacemaker

Here's an interesting one...

As a paediatric patient I had my pacemaker inserted into the abdomen but now that I'm an adult the latest replacement has been in the chest/shoulder. My old system has not been removed and the medical team don't want to remove it without good reason due to the risks of general anaesthesia and a redo sternotomy (it would have to be a sternotomy, I've checked). I fully understand these risks, although they may perhaps want to explain them again to me. 
My question is this - what are your thoughts? Are there any laws (UK or international) that state I have the right to removal of an unused pacemaker from my body?

This is an interesting ethical, moral and legal conundrum I know...

Many thanks


9 Comments

You have every right to ask for an abdominal pacemaker explant

by Gemita - 2020-11-19 03:43:58

I cannot point you to any specific legislation on this matter, but it is your body and therefore your absolute right to have your old pacemaker removed if that is your wish?  

My main concern would be the risks of removing as opposed to the risks of leaving in place.  The initial risks of removing would be greater than leaving in place, but the long term risks of leaving in place, for example, the cumulative risk for developing an infection during your lifetime would not I believe be insignificant.

It seems to me as though you need to weigh up very carefully your risk and benefits for each option, have a long meaningful discussion with your doctors and learn as much as you can on this subject before taking action. In the present climate they won't see it as either necessary or urgent and I feel you have time to decide to get it removed at a time of your choosing when it might be safer to do so and with a team of doctors who have the expertise in abdominal pacemaker explantation.

Not on the same scale of importance, but I had an implantable monitor removed (against my doctors wishes) last year.  

Thanks for the advice

by Parker0 - 2020-11-19 03:55:02

Good point on the short term vs long term risks - I've already had two skin infections near the redundant pacemaker this year and really don't want that to become an infection on the device.

I also see your point regarding short term risks - which for a redo sternotomy are not only the risks of opening the chest fully, but also as it's a redo - the risk of severe adhesion within the chest complicating the surgery. 
 

It's definitely a tough one but as you say I have time to think it over given the current climate and I don't have to make the decision or request now - I can request it in the future. 

considerations

by Tracey_E - 2020-11-19 12:36:44

I'm not sure how your health coverage  works in UK but if it's not necessary you may have trouble convincing them to do it. Me, I'd leave it alone unless there was a compelling reason to take it out. The risks of leaving it alone are lower than the risks of taking it out. I don't have an old box but I have capped off leads and have no intention of messing with them unless I have to. I want to leave well enough alone. 

Free NHS healthcare

by Parker0 - 2020-11-19 13:59:54

So long as I can convince the hospital trust, the board of directors or ultimately NHS England that this surgery has greater benefits than risks, and that having it will improve my life in some way - the total cost to me would be £0.00

Good idea re: cap leads and remove box as I guess then the main problem sort of gets dealt with and ultimately it can probably be done under local anaesthesia with fewer risks. 
 

I will definitely need time to think about this!

To remove or not to remove that is the question...

by stormynw - 2020-11-20 04:07:59

My only concern would be depending on how long you have had the original implant would be the potential breadkdown of the components and whether or not they might leach toxins into your system. I'm by no means saying that would happen but it is something to consider. I can't imagine that pacemakers were ever meant to be permanently left in the body. Anyway, just a thought. 
Best regards,
Damie Rodriguez

Damie

by Gemita - 2020-11-20 04:46:19

Very good point.  And then perhaps these toxins could cause an immune response triggering autoimmune disease or other illnesses and allergies and so the list goes on.  However the risks of surgical removal are also clear to see, so a real dilemma to face here.  

implants

by Tracey_E - 2020-11-20 11:53:35

Many metal implants are intended to be left in for life. My sister has plates in her wrist, my husband has pins in his ankle, my dad has rods in his back. Pacers are sealed. It's possible they could eventually break down but I've never heard of it. Until 10-15 years ago, they didn't even have the technology to remove old leads so when they were put in, they were never expected to come out. 

Initial inquiry made

by Parker0 - 2020-11-20 13:00:38

So I've made a little initial inquiry to my cardiac nurses, knowing and mentioning that it wouldn't happen for a while. I guess what now waits to happen is see what they say and respond based on what they say (tbh they'll say no I know). I definitely need to understand the risks/benefits before making any decisions - but like I said in the original post - I want to be free of that old system, and it's just whether or not it's worth it...

Attached link might be worth reading

by Gemita - 2020-11-20 13:29:01

Hello Parker0,

An internal corroding battery, although rare I know, can happen.  I came across the attached link from a 2018 Pacemaker Club thread.  Tragic actually.  Don't spend too long dwelling on it.  I'm sure it won't happen to you whatever your decision.

https://www.pacemakerclub.com/message/34432/st-jude-icd-battery-leak-and-corrosion-causing-severe-infection

You know you're wired when...

You invested in the Energizer battery company.

Member Quotes

I have a well tuned pacer. I hardly know I have it. I am 76 year old, hike and camp alone in the desert. I have more energy than I have had in a long time. The only problem is my wife wants to have a knob installed so she can turn the pacer down.