Pacemaker Replacement

My dual lead pacemaker is due for replacement next week, and the doctor said I should get an ultrasound of my heart to make sure it is pumping properly in case he needs to put in another lead.  This is making me nervous because just one more thing to worry about.  Does anyone have any experience with this?  Thanks so much, Holly


Third lead

by AgentX86 - 2021-11-16 21:31:25

This is absolutely nothing to worry about.  A pacemaker with a third lead is called a CRT (Cardiac Resyncronizatoin Therapy) pacemaker.  Occaisionally a right ventrical lead-only (typical 2-lead) pacemaker causes the left ventrical to enlarge, reducing it's "ejection fraction" or it's efficiency.  The CRT pacemaker resynchronizes the heart to minimize this effect and often corrects it.  What your doctor is doing is making sure that you get the appropriate pacemaker for your condition today.

Many of us have the third lead (mine's actually the second - don't have lead #1).  It can be difficult for the surgeon to get in the right place but there is nothing to worry about. The worst case is that you need the additional lead, which will make the surgery sort of like your original surgery. No worse. Otherwise it's a simple box replacement.

Smart doctor

by PacedNRunning - 2021-11-17 01:11:39

Pretty standard to do this before replacement especially if you are pacing more than 40% in the bottom lead. This will save you another surgery if your EF is under 50% after your new replacement. Better to know now vs in a few months and have to go thought another surgery.  My EP told me once my EF fell below 50% he would add another lead. I'm keeping my fingers crossed I won't need a 3rd lead for many, many years!!


by Tracey_E - 2021-11-17 08:36:36

Yep, it's standard to make sure your function is still good before a replacement. My ep is an adult congenital specialist so sees many patients paced long term. He said the need for a third lead comes up in well under 10% of patients, so it's not that common. And he said that once we've been paced 5 years, if the EF hasn't dropped by then, it almost never drops later due to pacing. I've been paced 27 years and my EF was 63 at last check, which is high for someone not paced. I have always paced every beat. 


by dwelch - 2021-11-24 23:13:54

It was not 50% I think I was below 50% EF normally, it wasnt until I dipped into the 30s that they went for the third lead.  and of course it was mid pacer, so device number four was only three or so years old when I got number five.   

Expect to get echos on a regular basis as you continue to have devices.  It is no big deal.  The third lead is no big deal either and it bumped my EF back up.

3rd lead

by islandgirl - 2021-11-25 01:10:41

I've been told I need a 3rd lead due to dyssynchrony, but at this time I don't meet the criteria as EF has to be 35% or less.  Mine is curretnly 45%.  My EP is frustrated because the long-term effects for me without a third lead will worsen my heart failure.  My device will be due for replacement within about 6-9 months (with the current battery estimate), and he is planning to appeal to be able to put in a 3rd lead, as he has all the data to show it will be beneficial for me. If my device wasn't going to replaced that soon, he would put it in now.

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