1 lead not working, doctor suggesting adding a 4th lead (patient already has 3 leads)

Hi, My father has had his pacemaker for over 10 years now, he is 66 now. We just learned that 1 of the leads that goes in the right heart chamber is not working properly and has to be replaced. The doctor is suggesting not to remove the lead but rather add a new one. My biggest concern is that he already has 3 leads passing through the vane (1 lead to the right, one to the left chamber, and a defibrillator), and adding a 4th one might cause issues with the circulation in that vane if it will get a bit "crowded" Has anybody had a similar experience? The doctor wouldn't say what are the chances for this complication to happen, if it does is it fatal? If it happens can it be fixed easyly? 

Thank you 


p.s. His Pacemaker is Medtronic and his leads are Biotronik


Not enough information

by crustyg - 2021-05-05 09:33:41

It's not clear if your Father has a CRT-D, but in any case, having an ICD-function doesn't necessarily mean that each lead is separate.

The anatomy of the vein used to get access to the heart (usually the subclavian) can vary, or be affected by previous instrumentation/treatments etc.  It can be visualised by injecting radio-opaque 'dye' into a feeder vein (showing my age here) or more probably on hi-res CT scan, or possibl MRI.

Risks of putting another wire in there: yes, not zero, and it's not easy to predict the risk of a clot forming around the leads, hence why your EP-doc declined to give a number.  It's uncommon and *usually* treatable with an oral anticoagulant.

There are contributors here who have had leads removed (specialist centre, need to be doing at least 100 per year to be good), and those who have non-functioning leads left in.

In your shoes I would be wanting a lot more information about my choices, a better understanding of why removal of the failed lead isn't being considered - but if the RV lead has failed and there's signficant heart block then you may not have a lot of time to consider your options.

As I say, I don't think you've provided enough information for us armchair folk to comment...

Thank you @crustyg

by Gabriela MK - 2021-05-05 18:59:34

To share more info, (hoping it's relevant as I'm just getting myself more familiar with this whole topic) His leads are Biotronik Selox SR 53 and Biotronic Linox. So I don't know if that's a CRT-D or not. 


But non the less what you share was super valuable as the doctor didn't even mention that there's a way to see if there's room for the 4th lead prior to the intervention so I'll make sure I ask for that. 


It sucks that we're in a small country in South-Eastern Europe and not only that we don't have hospitals that perform over 100 lead extractions a year, but we don't have hospitals that do lead extractions - period. 


So if there's anybody from Europe here that know a doctor or a hospital that specializes in this please share your experience



4 leads

by Good Dog - 2021-05-05 20:44:18

I currently have 3 leads and am considering an additional 2 leads. There are folks on these forums that have as many as 6 leads. It is much more risky to extract leads than it is placing new ones. The number of leads through the veins isn't really an issue as long as space exists. The doctor will or has already confirmed that is not a problem. It seems from your post that the doctor wants to replace the atrial lead. Since that lead does not pass through a valve, that should not be a problem at all. The only issue with the number of leads are those that pass through the tricuspid valve. More than two leads through that valve into the right venticle can result in excessive regurgitation and possible damage to the valve. Generally, doctors know not to place more than two through the valve. 

So what your doctor is suggesting sounds very reasonable and very safe. Not to worry!



I have four

by dwelch - 2021-05-09 23:14:48

I have a 34 year old lead that I use, a 34 year old lead that the doc broke on the first replacement. a 27 year old lead that I use and a few year old lead that I use.  When they put the fourth lead (switched from dual chamber to biventrical) in we talked about this.  One option was to tunnel across to the other side and down through there (across the chest basically and come down from the right side).  The other was to put it in on the same side and if there isnt room then remove the broken one out later.  But part of that was at the time of the procedure they would see if a fourth would work.  So it was a case of waking up to see what they ended up doing and there was room for a fourth (not every one is so "lucky").


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