Living in hope

Following my last post'No longer a success story' I received an appointment on Monday for Thursday 14th to get my lead replacement.

The surgeon said that the previous leads failure were caused by the subclavian approach.

If you want more information look up Subclavian crush syndrome. Basically it causes leads to fracture and insulation breaches to develop by compression of a lead between the first rib and clavicle.

My surgeon managed to extract the two failed leads and replaced them. My third lead was always intact. He said he implanted the pacemaker further down in a different way.

 I have read that the subclavian approach is easier than other methods to implant a pacemaker but if it causes lead failure in some patients why is it done? I didn't have an opportunity to ask him that but I have faith in this surgeon as he was honest. I was delighted the old leads were removed as this was a cause for concern for me.

I hope I have explained it reasonably-I have no medical training.

I am home now and recovering.  


6 Comments

Why is it done?

by AgentX86 - 2022-04-15 13:03:34

You said it yourself. It's easier.

It's good that they removed the leads and replaced them. You should be good to go now. It sounds like a success to me.

Living in hope

by Aberdeen - 2022-04-15 13:44:03

Thank you Agent 86. I hope it's 3rd time lucky for me.I was so worried that I would end up with 5 leads instead of 3!

So glad you are on the road to recovery

by Gemita - 2022-04-15 14:04:28

Dear Aberdeen,

Thank you for the update.  You have explained your difficulties well.  It is the first time I have read about Subclavian Crush Syndrome.  I see that a better first line approach is using the Cephalic vein cut-down technique or extra thoracic axillary vein puncture, both of which provide safer alternatives for central venous access in patients undergoing pacemaker implantation.  Subclavian Crush Syndrome using the Subclavian vein approach is a rare but known complication of pacemaker lead failure due to the compression of the lead between the first rib and clavicle.  I attach a link for further reading for anyone interested. 

https://pdfs.semanticscholar.org/f936/59aea4bc2f071ba801373727bfd4c73e4a61.pdf

I am relieved to hear that your redundant leads have been removed. This would have been my preferred outcome too.  I hope you are not in too much discomfort and that they took great care with your lead extraction.  Did your own team extract the leads and re-do the procedure, do you know, or did they receive guidance/support from anyone else?  Also I hope you were given your discharge papers and you can read all about your procedure, the techniques they used and where the leads reside. Hopefully you are not too sore or swollen.

I have just looked up my own dual chamber pacemaker insertion details.  I see they used Axillary/subclavian extra thoracic access.

Aberdeen, what is done is done and analysing what might have been is not going to help. Better to move forward with hope in your heart that it is fixed now and that your consultant has learnt a valuable lesson.  I wish you all the very best and hope that you are already benefitting from three fully functioning leads.  

Recovery

by Aberdeen - 2022-04-15 15:59:04

All the surgery was done by one surgeon who explained what he was going to do and how he was going to use a different pocket to put the pacemaker in. 
Since I was awake he told me that is the RA lead removed then when he removed the RV lead.( or vice versa
. I didn't get any discharge papers just the usual booklet what to do after a Pacemaker implantation.

 Thank you for your kind comments.

Thanks for the response

by Good Dog - 2022-04-15 17:09:11

Great news! As I have often said; only half the Doc's graduate in the top 50% of their class! I once read a study performed in Germany in which they did a follow-up on PM patients after they died. They actually explanted their pacemakers and checked their (history) records against the settings. What they found was alarming to say the least. I don't remember the exact number, but a huge percentage of the PM's were out-of-the-box settings. Their EP/cardiologist never adjusted them. So my point is simply that nothing would surprise me after reading that.

I'll say this; you are an excellent communicator. Thanks again for the details. I am happy for you that you have this resolved and put behind you!

Sincerely,

Dave

Thanks

by Aberdeen - 2022-04-15 17:17:51

Dave ,

          Thank you for your response and kind comments! I sincerely hope I have put all this behind me!

 

You know you're wired when...

You name your daughter “Synchronicity”.

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My pacemaker is intact and working great.