Pilates, Advanced Reformer Exercises

Hi All, I could use some guidance and advice.  I've had my St. Jude for about 6 weeks.  It was placed over, and the leads tied to, the left pectoralis, very near my axilla (arm pit).  I have serious ortho issues (alignment, posture) that I've kept at bay with Pilates and after years reached a very advanced level of Pilates (reformer and chair) with amazing results.  Today I showed my doc pics of typical moves and was told I shouldn't do them as I could rip the leads.  "Maybe I could do some in another 6 months." 

My PM came after 3 months of limited movement due to a nasty infection.  I was hoping to restart my pilates since it's important for me to keep the area between my shoulders through hips strong, stretched, and the strength uniform from side to side or my spine and hip "twist".  Due to the immobility of the past months my pain level and ortho issues have been inching up. I'm at a loss if I can't do the Pilates.  Does anyone have any exercise suggestions?  Just walking isn't actually isn't good for me.  Thanks, any advice is appreciated.



I think he's being too conservative

by crustyg - 2021-01-15 05:10:53

The issue is that the leads have a big swelling some distance from the connection point, and this is designed to make it easy to really anchor the lead - effectively the lead is fixed in three places: 1) at the heart muscle, 2) this lead anchor point, 3) the PM itself - which should also be anchored down - to a different location.  There *should* be sufficient slack between these anchor points to allow for a) cardiac contraction, b) stretching between the lead anchor point and the heart anchor point, c) between the PM and the lead anchor (often there's a loop of lead behind/underneath the PM.

The issue your doc is concerned about is how much slack he's left between heart and lead anchor.  Leads come in a small range of sizes and it's a matter of guidance and experience which length the EP-doc implants.

Modern leads use an active fixation into the heart muscle - a little metal helix/corkscrew that holds the lead in place, and over time tough, fibrous scar tissue grows around this to provide additional anchorage.  After a while, *typically* six weeks, this anchor becomes strong and there is almost no chance of pulling the lead out, unless there's a significant problem inside.

You should have had a plain chest X-ray after lead insertion and this is the key.  It should show plenty of slack in the leads between lead anchor and heart.  Mine does.  You need to review this CXR with your EP-doc and discuss what you *need* to get back to your previous level of upper body movement.  If there's not enough slack he's botched it.

Be prepared for some really sharp twinges of pain if you restart Pilates +/- Yoga - 'opening up the chest' really stretches things and the PM pocket will twinge for months when you do this.

Exercise, pilates,

by Selwyn - 2021-01-16 11:47:38

After 6-12  weeks wound strength is almost 80%. There is no point in waiting 6 months. ( ref https://www.woundsource.com/blog/wound-healing-process).

When getting my pacemaker inserted I told the surgeon that I wanted to swim and fully extend my arm so to leave sufficient slack on the leads to do this.  The leads should never be tight. Like wound healing the llead implant tip will be firmly fibrosed ( ie. scar tissue) in 6-12 weeks, depending on age etc.

If I were you I would start Pilates gently over the next 6 weeks, only doing what feels comfortable and starting of gradually increasing  the stretch. 80% of wound strength is in 12 weeks from implant so I expect you could do 80% stretching quite safely. If you wanted 100% then wait 6 months, however the last 20% of stretch is going to take another 3 months. There is usually not much tension on the wound during exercise. As  Crustyg says, the PM is fixed with non absorbing sutures and will not move unless in some way these are torn apart - you would have to do major trauma to the PM site for this to happen ( eg. car crash).

I was back swimming front crawl  as soon as I was happy that the scab had gone from my wound. 


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At age 20, I will be getting a pacemaker in few weeks along with an SA node ablation. This opportunity may change a five year prognosis into a normal life span! I look forward to being a little old lady with a wicked cane!