PM to ICD with lead extraction

Hi all,

I see there've bene numerous posts recently about swapping out PMs for ICDs. I am scheduled to have such a surgery in two weeks. (I am an otherwise healthy 52 yo female with PM for three years owing to bradycardia and complete heart block. I recently learned I have a rare genetic cardiac disease that also puts me at risk for sudden death. Hence the ICD.) I would love to hear from anyone on the forum who has opted to have a lead extracted (rather than left in place). After much research and discussion, this is what I have been advised to do. I have a very experienced doctor (in Boston at Beth Israel Deaconess) but I am very nervous, as I know this aspect of the surgery is risky. (I've read that being female is considered a slight risk factor for complications, presumably because of smaller vein size, making extraction more challenging?) Anyone have any experience with this surgery? I would love to know that there is someone out there who has been through it and put it behind them. 

Happy New Year and thanks!


Lead extraction?

by AgentX86 - 2021-01-01 19:48:54

I don't have an ICD but I was curious.  Why do you need the leads removed?  After only three years I wouldn't think they'd be bad.  AFAIK, the "upgrade" should be similar to a simple PM replacement, though the pocket may have to be made somewhat larger.

Lead extraction

by barnet38 - 2021-01-01 22:03:00

I don't have an ICD, but I had a lead extraction approximately two weeks ago.  I am a 39 y/o female with congenital complete heart block, and have been paced for 22 years.  While my generator had been replaced multiple times, I was still using the original leads.  Unfortunately, the ventricular lead malfunctioned and required replacement.  I had the option to either have the lead extracted and replaced (this was my EP's recommendation), or I could have the malfunctioning lead capped off and place a new lead in the same vein, with the understanding that this will make any future lead extraction more complicated.  Because I am young, must be paced for life, and have an outstanding EP who specializes in lead extraction, I chose extraction.  While it was riskier now, I know it was best for me in the long run.  

My lead had been in place much longer than yours, so I imagine that your surgery will be less complicated than mine was.  My EP used a laser tipped sheath to separate the lead from the vein where adhesions had formed.  My lead broke in the process, and the EP had to run the sheath up to my heart from the groin to retrieve the remaining portion of wire.  My new lead was placed on the His bundle.  I also received a new generator during this procedure.  The surgery took over 6 hours, then I had to lay flat for another 4 hours due to accessing the veins through the groin.  I stayed at the hospital overnight, then had a device check and chest x-ray (to check lead placement) before being discharged.

The groin area was sore for a while and I needed a lot of help for the first few days due to some bleeding at one of the incisions, but it is healing well now.  My pacemaker is placed very deep, but it has been healing well and feels great!  I was cleared for exercise earlier this week, and have been walking each day, plus riding 7-8 miles a day on my indoor spin bike.

Why does your lead have to be removed?

PM to ICD upgrade

by islandgirl - 2021-01-02 12:20:25

I had a PM for bradycardia and was upgraded to an ICD about 18 months after the PM implantation due to a SCA.  The EP removde the ventricular lead (the powered lead), opting not to leave it in because of MRI contraindications.  He was experienced with removing leads and I've been going to him since 1999, and I know he is very competent.  I remember my chest was sore afterwards. He did it with sedation, and made a comment afterwards that I was still exhibiting some discomfort but he had maxed me out on sedation.  I did not remember anything---and he knows I don't want to know what's being done!  My chest was sore, but no other complications.  I stayed overnight, the ICD was interrogated the next morning, and was released.  

thank you!

by heartbeat26 - 2021-01-02 17:12:33

Hi, all, 

I am so grateful for your replies; AgentX86: I opted to have the PM lead removed rather than capped off and left in place on the advice of my cardiologist and the two EPs with whom I discussed this surgery. The consensus was that the longterm risks of leaving the lead in place (infection, eventual failure) outweigh the short term risks of extraction (nicking my vein or my heart; emergency open-heart surgery, etc.). Although my leads are only 3 yrs old, I'm told that that is not necessarily a guarantee that the vein is not occluded or that extraction will be relatively straightforward.  

Like barnet38, I will have a catheter in my groin for fluids, emergency transfusion and as a possible avenue for lead removal. My surgery will be under general anesthesia.

I'm particulary nervous as my disease (PRKAG2, a rare genetic cardiac glycogen storage disease that causes glycogen to be deposited in my heart wall, resulting in a progressively thickened seputm and the resulting conduction issues) makes my heart rate irregular a lot of the time — lots of escape beats, in addition to chronotopic incompetence with exercise. I suppose surgeons know how to work with a hemodynamically unstable patient, but I am very nervous about this!

So good to know that barnet38 and islandgirl have gone through this and that the procedure went well. So glad to know you are out there!

Thanks for your comments.



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