New upgrade from ICD to CRT-D

I was upgraded from a Medtronic ICD to a St Jude CRT-D on Jan 21 due to battery drain. I have a 7-y/o RA lead from a PM, and a 5 y/o lead for the ICD.  My vein near my clavicle is slightly distended so my EP was giving me the worst case scenario of having to tunnel to the right side and put the 3rd lead into a vein on the right.  An ultrasound was performed in pre-op and I and everybody else was relieved when the US showed the vein open.  He knew he was also going to have a challenge because my ICD implant included an antibiotic pouch, which they no longer use.  So, with general anesthesia, I went to sleep relieved. The first words I remember after the surgery was my dr telling me it was the worst case scenario....the vein was closed (revealed with a venogram after I was asleep).  He was surprised to see not only the vein scarred closed with the leads, but also collateral veins had formed.  He had to tunnel under my skin across my chest to another vein, and then thread the lead in that vein to my heart.  He didn't have to move the device to the right side--that was one of the scenarios, but he would have to tunnel across.  I wanted the easiest way for both him and me. He said he had a lot of cleaning in the pocket due to the antibiotic pouch.  Recovery has been most difficult, with bandaging across my chest as well as both the left and right sides where I will have incisions when the bandages are removed 2 weeks after the surgery.  He said he did clean up my scar.  The surgery took 4.5 hours.  Last night I slept a little better, and I've learned to take my non-narcotic meds on a regular basis and the narcotic prescription at night.  The EP told me it was going to be very painful and it has been.  My LV is pacing 100% of the time as well as the RV and RA (sick sinus).  It is now synchronized and he hopes there will be some remodeling of the chambers. I am under strict orders to not raise either arm above my shoulders for 8 weeks nor lift anything heavier than a gallon of milk.  I will (without divulging to him) begin to passively raise my arms while lying in bed when the pain is better as I worry about any shoulder problems.  I am hoping this will reduce my VT, most recently atrial flutter, and give me more energy and strength and at least some of the active lifestyle I have been accustomed to.  

6 Comments

ICD to CRT-D

by AgentX86 - 2022-01-29 16:16:32

I'd try hard not to raise your arms, as directed.  Some have tethered them to their body to keep from raising it.  I slept in a recliner, which also helped take the stress off the incision.  That's the real deal - making sure the wound stays closed.  Of course I don't have any experience with the tunneling through to the opposite side but it can't make things somehow simpler. Sure, keep your shoulder moving but I'd listen to your doctor.  You can keep your shoulder active without raising your arm above your head.  Messing it up would be bad.  An infection would be really, really, bad.

Great news

by Gemita - 2022-01-29 19:20:58

Islandgirl, thank you for the update and I am relieved you have your upgrade at last.  I am really sorry you had such a long and difficult procedure but it sounds as though you are already feeling the benefits of your upgrade.  I do hope CRT-D helps to control your VT, Atrial Flutter and other problems and enables you to lead a better quality of life.  Take it easy with your recovery and don’t overstretch yourself in any way.  Hopefully your pain will ease quickly.  I am so glad you have got neuropathic Gabapentin to help with the chest pain.

Please let us know how you progress and how well CRT works to help control your arrhythmias?  CRT may take a little time to improve your EF, so please be patient and remember you have been through a traumatic experience, so you can expect a few arrhythmias until you heal.   Good luck, sleep well and take good care xx

Thank you AgentX86 and Gemita!

by islandgirl - 2022-01-29 21:52:41

Thank you for your positive thoughts, knowledge, support, and helpful opinions. My EP has warned me about how devastating an infection would be.  Keeping everything dry and EP will remove bandages at 2 weeks.  

Now to figure out when I can get back to work.  My clients know nothing about my heart problems and I need to figure out how I can put them off for another week.  

I need to figure out how I can put them off for another week.

by AgentX86 - 2022-01-29 23:52:16

Tell them you have covid? ...only half joking.

Congrats!

by Julros - 2022-01-30 02:15:49

 Congrats on getting your new device. Do take care of yourself. I don't know that your clients need to know more than you are taking an additional week off.

Yeah, go easy on raising your arms. With doc's approval, maybe some shoulder shrugs, pulling shoulders back as if to bring shoulder blades together, and rotating shoulders without lifting your arms? These are exercises that were given to my by physical therapy. Started with 10 repetitions each morning. 

Update from today's appt and Thanks for the Comments!

by islandgirl - 2022-02-02 23:57:15

Thanks all for your comments!  Thanks, AgentX86.  That will keep them away. LOL! 

Thanks Julros for the limited motion exercises. 

Found out my device is a Abbott/St Jude Quadra Assura MP CRT-D.  

Got my bulky bandages removed today and now light bandage that I can remove tomorrow before shower.  

EP wants weekly photos of incisions.  I see him again in 3 weeks when he will do another echo and attempt to synchronize better.  Something is still fused....wave or something.  

Waiting for Merlin remote monitor.  Delayed delivery due to upgrade to 5G.  When it comes in they will sync it to my device.  EP spent a lot of time fine-tuning device.  I've had some AT events.  He increased my rate from 110 to 120 and left my min. rate at 60.  I'm 98-99% paced in all 3 chambers.  He is hoping for remodeling to occur in 8-12 weeks.  I was quite disappointed to see my battery length of 6 years.  Hope it increases.  

 

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