Lead voltage

I went to my ep yesterday and during the appt he discussed the RV lead in my icd/pm. The voltage was 1.4. He ran some tests using the device computer and my voltage jumped all over the place. He called the Medtronic rep and spoke to him, as he had already left fthe office for the day (I was the last person of the day with a device). We went on to other things. His office called me about 5 and said they need to Schedule a NIPS procedure. 
Has anybody had voltage issues with their leads?  Has anybody had NIPS procedure?

My RV lead is just over 4 years old.  My RA lead is about 5 1/2 years old.  I've probably been shocked 20 times with appropriate therapy.  

I am paced 99.9% in the RA (SSS) and 99.8% in RV.  I have 8-12 months remaining on my ICD.

 


8 Comments

NIPS PROCEDURE

by Gemita - 2021-01-08 03:26:33

https://orlandocvi.com/clinical-services/cardiac-clinic/nipps/

hello Islandgirl, I have to admit I didn't know what a NIPS Procedure was until I looked it up and I trust I have found the right description (in link above) and it is helpful for other members.  

I hope any tests/treatment you may need keeps you safe from inappropriate shocks or worsening arrhythmias and that the voltage problem can be overcome without undue risk to you.  

I know you have confidence in your EP which is so important.  Has your EP given any indication of how the problem might be best fixed and whether this voltage problem may have contributed to your previous history of worsening ventricular arrhythmias?

I do hope for the very best
 

 

Voltage issues with leads? Quite a few have

by crustyg - 2021-01-08 04:29:03

Fluctuating capture/pacing voltages can be a sign of a cracked or failing lead or a developing problem where the pacing lead connects to the heart muscle.

Several contributors here have mentioned fluctuating voltage requirements as a sign that a lead was developing a problem.

A NIPS is just a formalised way of proving whether this conjecture is correct and identifying, as much as possible, exactly which component needs to be replaced.  Rotten luck for you, but since you were expecting a box change quite soon, perhaps the (hidden) silver lining is that it may all be done/fixed in one session after the NIPS.

NIPS

by AgentX86 - 2021-01-08 11:50:42

NIPS looks a bit drastic to be just a lead diagnostic tool. Walking right up to the edge of Vfib and looking into the abyss, hoping that your ICD does its job seems like a pretty serious diagnostic.

As Crusty points out,  you're due for a generator change so whatever they find may push it up some. Perhaps they want to get this test in before the swap to use the old battery.

In any case, I'd have a long talk with your EP.  I'd want to know what they're trying to find out and what to expect.

Lead problems

by Selwyn - 2021-01-08 13:11:07

These acronyms: NIPS, a non-invasive programmed stimulation ( thanks to   Gemita) .

Never had one. Do have a lead problem.  I need an increased voltage to reach the threshold level for venticular contraction. This does produce an abnormal drain on the battery. However, in my case, I am not paced that much with the venticular lead. The other thing to look at is impedance of the lead as this will change as a measure of electical resistance. 

Any sudden changes with voltage needing to produce a contraction of your ventricle indicates a lead problem ( from PM to tip of the lead in the ventricle) in my mind.  My slight lead problem is being left alone. The bigger the problem the more likely you are likely to need a new lead, I'm afraid to say, so I expect the NIPS testing will give you the answer.  

Hope all goes smoothly for you and that the problem is sorted as soon as possible.

 

Thanks for the comments

by islandgirl - 2021-01-08 20:32:14

Thank you for the comments and information.  
I will let you know what I find out.  
 

 

NIPS tomorrow

by islandgirl - 2021-01-21 18:29:40

Tomorrow I have the NIPS procedure.  My EP called me yesterday to discuss the procedure with me.  He believes I have a failing lead.  He said he will adjust the PM/ICD settings in the atrium first, then put my heart in ventricular arrhythmias to make sure my lead will convert me.  He said it will take 20-30 min.  He said I will have a chest xray first.  

I'll let you know how it goes.  Pretty nervous--always nervous around hospitals--and concerned ICD won't convert and I would need new lead.  And, insurance (Medicare nor private) allows ICD replacement before EOL mode.  It astonishes me of the additional risk of infection and expense of getting a device change possibly less than a year after a lead change.

Trying to say positive.....

I had NIPS

by islandgirl - 2021-01-24 12:35:40

Unfortunately my NIPS indicated a faulty (probably fractured) ventricular/power/shocking lead and also an atrial arrhythmia. The EP wants to ablate the atrial arrhythmia.  He told me I've been having more and more episodes, and I had previously told him I was having worsening arrhythmias, some making me very lightheaded.  I am being 'paced out' of some, preventing it to progressing to a ventricle arrhythmia.  

I see the EP on Wednesday to find out what the plan is....  I am beyond frustrated and upset.  It is unknown why my heart continues to create new electrical pathways.  However, I didn't ask him if this is an area that had been ablated in the past.

 

Fractured lead?

by heckboy - 2021-01-25 13:32:21

I was having episodes where I'd feel dizzy for a few seconds even while sitting in a meeting. One day, while walking to lunch, I thought I was going to pass out. It turns out that I had a fractured lead. They scheduled a lead removal and replacement (my second). Funny thing was, the fractured lead was the new one from my replacment on 08. I still have my original lead from 2004 despite this being my 3rd PM.

 

Chris

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