How quickly do faulty leads need to be replaced?

Hi all,

My cardiologist recently told me that one of  my leads is playing up and I need a new pacemaker (battery is running out) an a new lead. Basically, a holtier ECG revealed that my heartbeat went down to 40 bpm for very short periods on two or three occassions throughout the 24 hour period, due to the faulty lead. He thinks that the lead is working fine 99% of the time, but is concerned about the issue, and thinks that I need the lead to be replaced soon. I had a pacemaker implanted 14 years ago (had the battery replaced 5 years ago) for a complete heart block - I am not entirely pacemaker dependent and have an underlying heart beat of about 40 bpm).

He wanted to opperate almost immediately, which I could not agree to due to the fact that I was not ready to make the decision so quickly, as well as the fact that he was very cavalier about the whole thing and said that he will try to put the new lead in the same vein, but if that does not work he will move the pacemaker to the left side (currently on the right side). I want to talk to another specialist about my options, including potentially removing the faulty lead. 

My question is whether a faulty lead is a serious issue that needs to be resolved very quickly? As indicated, I would like to go to a new specialist, discuss my options, and plan ahead, such that this gets resolved in 1 or 2 months. The doctor wanted to operate next week, but my sense is that the rush was mostly due to his convenience (he was quite pushy, and said that if I do not agree to the operation next week, he does not know whether he will have time to do it later on...).

How long have any of you that needed to have your leads replaced waited for the operation from the time the issue was identified?  

Many thanks for any comments on this point.



by PacedNRunning - 2023-01-27 03:40:04

I've never had a lead changed but if I have complete heart block. Which I do and my underlying rhythm is 40, it should be done sooner rather than later. It's not safe for you. Not sure how much you use the lead but 99% working doesn't sound like a lead than needs to be replaced. Do you trust your doctor? Lead failure for someone who' depends on pacing can be in trouble if it fails suddenly. You are protected by your underlying rhythm but they can be unreliable. 

Tricky Decision

by SeenBetterDays - 2023-01-27 07:28:25


I haven't yet had a lead replaced but, in your situation, would want to know the potential consequences for you if the lead failed.  You have mentioned that you have complete heart block but you have an underlying rhythm.  I also have complete heart block but no underlying rhythm so, for me, a faulty lead would be critical.  Maybe for you the situation would be different?  I would want to get specialist advice just to make sure.

You mentioned that your cardiologist seemed "cavalier" which makes me think that you don't have complete trust and faith in him.  I think it may well be worth another opinion in that case dependent on how quickly you can access that advice.

I'm sorry that you're in this situation and having to make such a tricky decision.  I personally think that if your instinct tells you that you need to speak to someone else,  that is what you should do.  Even if the outcome is the same, you will feel more reassured that you are going down the right path.  You need to have confidence in the advice you are being given and you need to have as much information as possible before deciding on your course of action.

I wish you well and hope that you are able to get timely advice and support on this.


Depends on the fault

by Gemita - 2023-01-27 07:48:49

Historian, hello, I haven’t had a lead change yet either but I would go by your symptoms to determine how urgently you need to act?   Did you feel any symptoms during your holter monitoring that coincided with your short periods of a heart rate drop down to 40 bpm? I see you have complete heart block, so you could still get into trouble even with your underlying rhythm.

From your comments, I have to say I don’t really understand your cardiologist’s manner unless he has discovered something about your lead that he is not telling you about that might cause complete failure at any time?  I note presently the lead is functioning 99% of the time, so the picture is rather confusing.

A faulty lead can of course be a serious issue if a patient is pacemaker dependent.  You need to ask your cardiologist exactly what has happened and depending on the problem and your dependency on your pacemaker with your heart condition, this will determine how quickly your lead needs to be replaced.

Like SeenBetterDays and PacedNRunning, I feel it is important that you can trust your doctors and if you feel there has been a break down in confidence, it might be time to seek a second opinion.  You need to get all the answers before you can make an informed decision.  Good luck and please let us know how things progress.

get another opinion

by Tracey_E - 2023-01-27 09:46:45

Is this doctor older? Because that's an old way of thinking. 

Go get another doctor if you can. I had one of those. No thanks. I was not under any circumstances going into a surgery with someone so cavalier about the turnout, about what I'd wake up with. Moving to the other side is a last resort. It's best to save it if at all possible in case the day comes you can't have the box on the current side. 

If they are faulty but stable, there is no rush. I had the bad lead for 5 years before we replaced it. It worked normally but drained the battery quickly because they had to turn up the juice the get the signal through. Think running the AC with the window open. But it worked so I made the choice, with my doctor's agreement, to hold off as long as it kept working. It was my ventricular lead, I am 100% paced with that lead and have a very low underlying rate. I was never in any danger and made a fully informed decision to wait.  

It's unlikely, but possible, that the issue is programming and not a faulty lead.

If you can get by as is, wait until the battery needs replaced and do it all at once. 

They can do a venogram, which is an iv with dye done in the cath lab which shows them how much space is in the vein. Very easy way to find out if adding a new lead and capping off the old one is even an option. That's what I ended up doing. The old capped lead is still there, my other original lead is still working great at 29 years old. I am now out of room so when one of the current leads is faulty, they'll extract all of it. 

A lot of doctors have changed their thoughts on leaving old hardware in and prefer to extract and start with a clean slate. This is why I asked age of your doctor. 20 years ago, extraction was unheard of. 15 years ago, it was high risk. Now it's considered routine and is low risk when done in the hands of an expert. 

My reason for not wanting to do that was I was in my 40's at the time. If I could manage another 10-15 years without extracting, I'd likely get by with only one extraction in my lifetime. That also meant more time for extraction technology to improve, which it has drastically. So, for me, in hindsight it was the right choice. I'm 56 now, still on that first set of leads, same side, no extraction, coming up on 30 years. If I were to extract tomorrow and the next set lasted as long as these, that would get me well into my 80's. 

If they extract, they will take out everything and start fresh. On the bright side, leads have come a long way in 15 years. Newer ones are place differently, are thinner and tougher. So there is a valid argument to get new leads. 

If you end up with extraction, you don't want just want anyone doing it. You want someone who specializes in it, ideally who does 100+ a year. 

Hope that's more helpful than confusing!

Faulty Lead(s)/Complete Heart Block

by Nina38 - 2023-01-27 09:47:06

Hello there everyone. 

Historian- I have experienced a fault lead and it was an unpleasant feeling. In 2010 I felt fluttered/palpitations on Christmas Eve... no dizziness but feeling that was an indication there was a problem. I went to the ER to be told I had a faulty lead. As a complete heart block patient it needed to be replaced asap. And it was within 3/4 days. However the fault lead was not removed because it was there for a loonggg time. And there could of been risks if they attempted to remove it. So my cardiologist added a new lead in the same location. My pacemaker has always been on my left side as well.
Thankfully it healed well and never had any issues. I am not on medication at all either.

So do faulty leads occur... yes. Do I trust my cardiologist? I do. At that time, I was very fearful so I questioned him. I think it's normal to question when something happens to us that we have never gone through before... it can be scary.
The most important thing for me was watching my symptoms (which I had) and the risks of having a fault lead not working properly for me (which it was quite obvious). Knowing those two things I had no option but to trust my cardiologist and stay positive. One thing I am sure about is, we are our best advocates. It's great to ask questions to our doctors and nurses and even do research. So ask away. :)
I hope this helps somewhat. 
best wishes and quick recovery. 

Faulty leads

by Aberdeen - 2023-01-27 14:27:09

Over a year ago I began to feel unwell occasionally. Breathless at times , dizzy and out of sorts. My doctor arranged a cardiology appointment in November 21. I have moderate mitral valve prolapse so my symptoms were said to be related to that. I declined surgery for a little while as it was not happening on a daily basis.

In April 22 I received a call from the pacemaker clinic (I have a bedside monitor) saying my leads were showing abnormal readings. They saw me the following day. 5 days later I was told to come in for surgery in 3 days time. 2 of my leads were failing and draining my battery. I have 3 leads- a CRT pacemaker.

Because my leads were less than 2 years old the surgeon managed to take them out and replace them with new ones. 
Since then I have felt well. 
Wishing you well!

Thank you

by Historian - 2023-01-29 03:48:56

Thank you all for your comments and sharing your experiences! This is all very insightful.

I intend to make an appointment with a new cardiologist soon, and work with him through the various options. I am not fixated on having the old lead removed, but do want to discuss all options in a clear way. I just don't trust my old cardiologist, and cannot accept his attitude of expecting me to blindly agree to whatever option he suggests.

Again, thank you all for your support!

Replacing Lead.

by trekkienurse - 2023-01-30 14:34:38

Hi Historian,  I just had a new pacemaker and a new lead placed on 1/27/23,  I would say that it depends which lead needs replacing.  In my case it was the Ventrical Lead that needed to be replaced because it was buried in the heart tissue.  But I only pace from the ventrical 1% of the time.  I pace from the Atrium 100% of the time.  If you are pacing high in the lead that needs to be replaced I advise gettting it done.  I was told a year ago that my lead needed to be replaced and the  doctor said that we would replace it when we replaced the pacemaker.  The leads are not removed.  It is done, but it is a very delicate procedure and most doctors are not trained to do that.  There are mixed views on removing leads.  So like I said it depends how much you are pacing with the lead that the doctor wants to place.  Hope this helps,

Hope all goes well.

This is so helpful!

by Kcambridge - 2023-02-03 12:28:55

I was just about to post with almost this same question. I am 100% paced for complete heart block, and my doctor called me yesterday to tell me I need a new lead or that they need to change my pacemaker settings to compensate for the broken one. (I have been getting increasingly frequent dizzy spells and was put on a Zeo monitor, which revealed I was somewhat frequently slipping into 2nd degree heart block.) Anyway, Tracey_E, your post was especially helpful for me in thinking through what to do about my own situation. Thank you!

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