any insights on why leads fail?

My husband just had his 3d pacemaker surgery plus ablation in a year. 2 lead biotronik was placed in July.  One lead failed in late July and was replaced.  Then he began having lightheadedness early this year.  We switched EPs.   Turns out he was having atrial flutter plus a failed lead.  So he had ablation and  now yesterday a lead revision.  Could it just be bad luck on the leads or what else could be going on?  Thanks for any insights!

 

3 Comments

Leads fail for a number of reasons

by crustyg - 2021-05-29 18:23:01

Poor contact at the lead=>heart muscle, failed connection to the heart (not always possible to us active fixation), leads fail from mechanical flexing, leads pushed up underneath bone (usually clavicle), leads slightly damaged at insertion but becomes clear later, lead not properly locked to PM.

There is a video of mechanical lead testing which shows how much care the vendors put into their products.  No-one can predict how well a lead=>heart connection will last (again, the vendors do everything in their power to prevent fibrosis right at the tip - leads all have a tiny amount of dexamethasone which elutes from the very tip to keep that electrical connection as good as possible while the main fibrosis around the outside of the lead anchors it for good).

Apart from those who break leads due to massive physical exercise, failed leads are *usually* either a problem at the heart junction or a reflection of the skill+expertise of the operator.  They do wear out, but not in 1month or 1year.

Lead failure

by ROBO Pop - 2021-06-01 18:23:49

There are many failure mechanisms for leads. Anything from mechanical stress, to defective materials, to human error during manufacture or handling. Even when installed the EP can inadvertently cause damage. They're man made and don't last forever. For that matter, your heart was made by God and it's failing, so I guess the answer is nothing lasts forever

all of the above

by dwelch - 2021-06-02 01:01:56

could be bad luck.  could be something he did, could be faulty products, could be a bad surgeon, could have been bad handling between the factory and the operating room by the folks that are responsible for that.

Please do not turn this into a fear of moving about with the next set of leads or any future devices.  Expect it not to happen again.  Find a good surgeon (my current EP and surgeon are not the same person, but have had docs that did both for me).  ask to meet the surgeon before the repair or next replacement.  

In some number of months it may turn out that there was a bad batch of leads from that vendor.

 

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