Swelling after insertion

Hi all! Well I had my third lead placed and device upgraded. UPGRADE DUAL PM TO CRT-P (Left). The procedure went pretty well but I have a good deal of swelling under or around the device.I have been on warfarin therapy for decades for valve replacement surgery and I imagine it is a hematoma. I saw my surgeons nurse who looked at it and was not overly concerned. I need to keep an eye on it for troublesome changes or signs of infection of course. The surgeon said it will take 3 weeks to see any improvement, it's been two weeks now and I could swear I am seeing a remarkable positive change. Is that possible? I have this subtle yet profound sense of a return to a normalcy as if things are right again. Does that make any sense? I still have dyspnea on exertion and my energy window is pretty narrow but even those seem to be improving. All in all I am really cautiously optimistic! 

any thoughts or ideas about the swelling would be appreciated. I saw some scans of my chest and with the valve and the PM and all the wires I look like a walking hardware store ;)


Haematoma ( blood clots) around the PM site after insertion

by Selwyn - 2021-07-24 13:58:49

Blood oozing, when anticoagulated , is not uncommon when you have surgery.  The larger the collection of blood the longer it takes to resolve. Rarely,  this may not happen, and the blood needs to be drained, and even rarer is fibrosis and calcification.

Be reassured the vast majority of haematomas  will resolve in a few weeks. As long as progress is in the right direction you are doing OK.

If the swelling is worsening, there is worsening pain,  and redness, any of these things would mean you need to seek medical help.  

Do not fiddle with the swelling. Massage does not help.  Sometime the blood clot can track and there appears to be extensive bruising. Such bruising always resolves changing from purple, to green, to yellow.  Superficial bruising like a 'love bite' (hickey)  usually resolves in a week so that by the next weekend your lover may start again!

Glad your procedure went well and you're feeling better

by Persephone - 2021-07-24 14:04:28

...and swelling... I have not (yet) been in your shoes, but I had significant swelling when my 2 lead PM was implanted... I remember the big eyes of the on-duty doc from my cardiology practice as he remarked about the extent of the swelling, but anyway, that was just my experience and it did reduce and became flat after many months.  Wishing you continued improvement.

Good to hear from you

by Gemita - 2021-07-24 14:47:43


It is really good to hear from you and to know that you feel better already.  What a positive sign that is and once you are fully healed and the swelling has gone down, you should feel even better.  I am a little curious because I thought you were getting a CRT-D, but I can see that it is a CRT-P (so no defibrillator)?

The CRT-P device is of course larger than a dual chamber pacemaker device and so you are likely to get increased swelling for a couple of weeks.  A hematoma, if present, can become quite widespread as it drains and breaks down, so don’t panic.  Mine took weeks to clear.  I was told to ice the area to help with swelling and inflammation, but follow your clinic’s instructions and please report anything you are concerned about, particularly increased redness, swelling, skin feeling hot, oozing smelly wound, swelling extending beyond device area, increased pain, increased bruising.  Cannot think of anything else to watch for, oh perhaps an increased temperature, but hopefully what you are experiencing is all perfectly normal.


by simonsimon - 2021-07-24 17:39:59

Yes, I'm a little confused about that too. After the weekend I'm going to double check, but it says I got a  CRT-P

Procedures & Surgeries
Procedure(s) (LRB):

not sure if that is good or bad at this point 



by Gemita - 2021-07-24 19:15:14

Simon, well what has happened so far has been good in terms of you feeling slightly better.  Did they actually tell you verbally that they would be putting in a defibrillator or was it only confirmed on your "procedure papers"?  I know you asked about what those codes meant and we found a list of codes to confirm a defibrillator.  You were going to ask your doctors, I think to explain why a defibrillator?  

Yes I would ask on Monday but I feel sure they will have put in the most appropriate device for your needs, so be happy with what you have and continue with the positive thoughts for a speedy recovery and a healthier Simon. 

I now have a CRT-P

by simonsimon - 2021-07-26 12:42:18

I confirmed my understanding with my doctor ps office. Their reply...


I now have a CRT-P, which is a cardiac resynchronization therapy device pacemaker. Your ejection fraction based on your last echo was stable and a defibrillator is not indicated. If your heart function was 35% or below, a defibrillator would have been discussed.

Excellent news Simon

by Gemita - 2021-07-26 14:01:23

That is better news than I expected and one less thing to worry about.  That gives me even more hope that you will make good progress with resynchronization therapy.  Until and unless a defibrillator is needed, you are better off without it.

Hope the swelling is easing as each day passes.

You know you're wired when...

You get your device tuned-up for hot dates.

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It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.