Life expectancy of a lead

Hello, 

What is the life expectancy of a lead? I've heard it is acceptable to review every 20 years, adding a new one or extracting the old one (which has risks) I have a DDDR PM dual chamber, RA lead is doing fine, RV apical lead has problems, dislodged at first attemp, made a scar tissue and needs high voltage, i'm not sure but sth like 8mv is required for safety margin, which i think drains more battery. What would you do if you have a 20 years old lead? This gonna be my 4th PM, congenital AV 3rd Block, paced since 2002, i'm 35 years old.

One more question, have you ever hear an abruptly broken lead? 

Thanks for your concern.


6 Comments

Old lead

by AgentX86 - 2021-12-27 21:32:32

I'm a reative newb but, yes, the higher voltage will drain the battery faster but the choice is to replace everything today or let it go until the battery runs down and it all has to be replaced anyway. 

Removing a lead does have risks but they're getting much better at it.  Laser tools are used to cut through the tissue embedding the lead. It's advisable to go to an EP who specializes in lead removal.  I'd look for one who does at least a hundred a year.  You'll probably have to go to a large theaching hospital in a major city to find a such a specialist.

Twenty years is exceptional.  Count yourself fortunate. Ten years ago lead romoval was a much bigger deal.

Lead extraction

by Selwyn - 2021-12-28 06:09:56

The life expectancy of a lead is the same as a length of string. There are many variables, not least what your physician wants to achieve for you, and how much use the lead has, including its flexility related to life style etc.

If a lead is not working 100% efficient (as my ventricular lead, at this momement of time), then there is a balanced decision to make between battery drainage, use of the lead ( not everyone is 100% paced), and removal. 

Removal, in experienced hands has a high success rate ( eg. 95%) and a low complication rate ( eg. < 2%), though there is always the chance ( <1%) of serious complications/death.  

Old leads can be left in place. New leads have better technology and may be MRI safe.  There is a limit to how many leads your subclavian vein may accommodate. Being young, means you are more likely in the future to need more leads, therefore there is more benefit with time, to you, in having a useless lead removed.

At the end of the day, any decision to reposition a lead will be taken by your physician with your consent and understanding.  You may want to have a discussion about His bundle pacing?  It is entirely an individual decision, as is the degree of risk one is willing to accept. 

I think, as you are young, I would not want to have old leads lying around inside me. There is limited capacity to your subcalvian vein and you have a lot of years ahead.  Also, your right ventricular lead goes through your tricuspid valve and this affects the leaf margin, producing a little incompetence ( leak), and so the more leads, the more incompetence. In good hands lead removal is more or less virtually guaranteed ( though note, the more or less!). In general the less fiddling that is done to your body the better.  I am almost double your age.  My PM ( my first)  is now 14 years old, as is my not so good lead. It is almost certain that I will keep the not so good lead and accept that the additional battery drainage is better than having a 2% ( 1 in 50 ) complication rate from lead removal.

 

lead life

by Tracey_E - 2021-12-28 16:48:27

Every doctor feels differently about handling aging leads. 

I had one lead go bad at 15 years. It was still working, I was 40 at the time. It had to be turned up to get the signal through, analogy given to me was running the air conditioner with the window open.  The houes still cools but the power bill goes up. We just watched it until the battery needed replaced. That one had a shortened life, about 5 years. I chose to keep the lead through that battery replacement. It got worse and that next battery only lasted a little over 2 years so in hindsight I should have dealt with it sooner. 

When it was time to replace it, I had a doctor who wanted to extract and start fresh. I chose to keep it and add a new one. When I explained my thinking, he agreed with my choice to wait.  My reasoning was I have a lot of years of pacing ahead of me and I was hoping to put off extraction long enough that I'd only need it once. If I'd started over at age 40, I would have likely needed that set extracted at some point. I'm 55 now. My now 10 year old newer vetricular lead is still working great. My original atrial lead, now 28 years old, is also still going strong. If I had an extraction tomorrow and my next set lasted as long as this set, that would get me well into my 80's. I haven't had any complications from having the old lead in there capped off, though my xray looks a bit like a bowl of spaghetti. 

Average lead life is 15 years so 20 is good. We have members here with leads as old as 40 years that are still functioning. Once they have to crank it up to get it to pace, it will shorten battery life so it's up to you when you feel it's time to replace it. IMO, batteries are easier to replace than leads so I wasn't in any rush to fix the lead.

Lead life

by Finn - 2021-12-29 22:41:28

I had a a lead go at 8 years, in my initial PM. At the time of surgery the second lead went as well. Tendril lead. Dr and I decided to extract both leads , not leave them in since it was only 8 years. The longer you wait the more difficult it is to remove .

They use a sheath laser, it is risky. My recovery was a bit difficult, some plurasy. 
make sure the Dr has done many of these.

 

old as you

by dwelch - 2021-12-31 01:30:04

I have four leads now, one is broken and not used.  Lucky I guess I have room for all four on the same side.

My first to leads are your age (note at least a couple of us that have responded also have CCHB and are long-timers).  About 34 years old.  On the first replacement the doc said oops, what do you mean oops.  Broken lead, so I got another, back then, it was a big deal to remove them.  Then another thing you may deal with, they should start watching your ejectcion fraction (EF) with an echo every year, being RV paced for a long time throws things off.  Took me around 30 years I guess, am on device number five which is a biventrical.  so I needed another lead.  one lead is 34 years old another 27 years old and the third in operation is a handful.  (three different brands).  

Will a fourth fit?  Do we remove the broken one, do we "tunnel" to the other side.  You me and a few other CCHB folks on this site may some day need to "move to the other side"  try to get as many decades on one side then can start fresh on the other.  One option was to run a lead down the right side and across to the pacer on the left. Was told that lead could be used later on the right when we moved over.  Other was to put the fourth in on the left and remove the broken one with a separate procedure.  Didnt need either, have four on the one side.

I have not had the mri safe talk about my leads.  My device is farily new so it should be, but are my old leads?  Back then was told very much no, no mri period.  Things have changed.

Yes a broken or cracked lead will take more energy to do the same work as that causes resistance (V=IR same current increased resistance, increased voltage.  P=VI power equals voltage times current, if I stays the same and voltage goes up then power goes up).  A normally placed and working lead develops scar tissue as well, part of the reason you come back after a new lead a few weeks then months.  To tweak things.  Modern pacers are much better at this than my first one that took many trips that first year to get dialed in.

I would actually not trust a doc that wants to just remove leads based strictly on age.  You remove them when you need to remove them.  Certainly with us where we have decades worth of devices you dont want to put devices in every 5 years if you can make that 10 + with a better lead.  When you go in and they do the interrogation it is checking these things and, as you know, they see the lead has issues.  if it did not then they would not be having this conversation.  Point being, they are keeping track of the leads heath.  

As you know from the interrogation there is a point where they turn it off and basically see your complete heart block, so you know how it feels.  If a lead were to just fail completely or break to the point that the pacer could not do its job with the settings or range available you should feel that and make the call.  The other clue would be your heart rate would go back to the old slow rate (I assume yours was slow like mine was).  If it drops below your programmed minimum then, make the call.  it sounds like in your case is that the lead is just not optimally seated and has a higher resistance that results in higher setings and more battery consumption.  I have not changed my opinion on this since I dealt with it, plan A, add a new lead and see if there is room.  Leave the old one in.  But then what is the plan B do you tunnel over or do you go for an extraction?  At your age, probably do the extraction, but I also see Tracey_E's point.  I told them I wanted them to tunnel over if it didnt work, but at the same time I was not happy that somehow this was my decision, or they made me think it was.  I am not the doctor here, ill do my job you do yours. 

anyway in my case it was deferred hopefully for a few more decades.  and hopefuly the same for you.  You do want to have some good leads though that dont burn thorugh so many batteries.  Probably best to check the battery often and just take care of it when this device is ready (rather than jumping in early)

 

Thanks

by AzizeIpekbayrak - 2022-01-04 02:45:53

Thank you very much for your invaluable comments 

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