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Hi, I had an attempt at placement of a leadless pacemaker, Micra, and the doctor made 4 attempts b/o high impedance.  After the 4th, they noticed that I had pericardial tamponade, and I became comatose and was in ICU intubated for 4 days, delirious for another 3, and recovering my faculties.  I am now trying to understand my chart and what happened to me.

The surgeon made four attempts at placing the pacemaker; each time he found impedence was too high.  What does that mean?  I'd think if something is wrong once, you might stop , and not use that pacemaker anymore.  But he kept trying. Is this normal?  He told me on my followup visit that my ventricle is too small; but i have a lot of echo cardiograms, all of which say my ventricles are normal size.  I know if November, the FDA warned about the Micra, but if this surgeons is like others, he never reported the incident, so the incidents are clearly undercounted.

I was in a coma for a week, and now I'm recovering.

But I'd love help in understanding that.

Can anybody explain to my why this happened, or what it meant that he had high impedence and kept trying?  

Thank you so much,




by AgentX86 - 2022-07-30 20:56:53

I high impedance is usually because the leads (tines) don't connect properly to the heart muscle.  It takes more voltage to get the right current into the muscle, hence the "high impedance"  Current = voltage / impedance.  If the impedance is high, it takes similarly high voltage to get the same effect. A higher voltage requires more battery. If the impedance is high enough, it has to be fixed, somehow.

Remote diagnosis is difficult and dangerous - and you may be heading to your lawyers....

by crustyg - 2022-07-31 11:14:19

...but my *GUESS* is that he managed to attempt the implant into the anterior wall of your RV - which is quite thin.  It's not always easy to see which part of the heart is being worked on using a top-to-bottom fluoroscopy view.  The fixation spines on the Micra look quite aggressive, and it appears that at some stage in the procedure the fixation spines penetrated right through the RV anterior wall and the subsquent leak started to bleed => tamponade.

Blaming your anatomy "ventricle is too small" is unlikely to stand close scrutiny if you have echoes/CXRs which can demonstrate normal size.

Depending on how upset/angry/litigation-minded you are, you might want to get your entire set of charts and ALL imaging studies reviewed by another EP-doc.  I suspect you won't be going to back to that one.

But, as I said to *my* EP-doc (number 5 for me), I'm one of the few patients who truly understand that the consent form for ablation / PM+lead placement does warn that one of the complications of the procedure includes death.  Not often, but it can.

Reaching for your lawyer will tend to trap you in the past, reliving the anger and sense of betrayal of something that went wrong.  And it did go badly wrong and I feel for you - it was a truly horrible experience, but one that happily you survived.  The mental health experts like to remind us (and especially *me*) that anger only burns yourself.

An alternative for you is to get the pacing problem fixed by someone else (and perhaps not with a leadless device) and get on with living your life.

In the end, it's your choice.

Consent form

by AgentX86 - 2022-07-31 13:42:25

I've never seen a consent form that didn't say that one of the possible outcomes was death. Anytime anesthetics are used it's a possibility.

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