Changing placement of pacer

Hi there - My doctor (who is my cardiologist, ep, and surgeon) recently called me to tell me that I have a broken lead, which is an issue b/c I'm 100% paced (I have an underlying rhythm of ~33 bpm). He said I may need surgery to put in a new lead. I also will likely need my battery replaced in 1-2 years, and so we'll likely be changing settings to muddle through with the broken lead for a year, and then surgery to replace everything all at once. My question:

Has anyone ever successfully convinced their surgeon to implant the box in a different spot?

My dual-lead box is currently on the left side in the traditional spot near the surface of my skin. I lead an active life -- I exercise, I shovel snow, I wrestle with and pick up and carry my 45 lb 5-year-old, etc. I am sure this is why one of my leads broke. I don't intend to slow down my activity -- I'm only 40 and apart from the complete heart block am totally healthy. 

I am under the impression that if the box is instead implanted in my pectoral muscle or something, the surgical recovery may be longer and more painful, but my leads will be more protected.

My ep/surgeon is highly well-respected in the hospital where all my doctors are, and honestly a smart and really nice guy, but I'm concerned that he's more traditional and used to older/less mobile patients and may not be as open to this idea.

Have any of you made this switch in placement? How did you make it happen?



Technology Advancing

by Penguin - 2023-02-04 16:33:53

With nearly two years to go until replacement, is it worth considering that technology might advance sufficiently in that time to allow for a leadless device that works for your condition?

Bit of a long shot but not impossible. 

I can't help with your Q. I'm afraid but I'm sure someone will come along who can. 

Life sounds exhausting but fun in your world! 


moving it

by Tracey_E - 2023-02-04 16:51:26

They should absolutely be able to move it when you get your next one! If your ep seems hesitant, ask about having a plastic surgeon assist. My ep suggested it, he didn't want to mess with it but understands why I want it out of the way. Easiest job of the day for the plastic surgeon, the ep could concentrate on what he does best, and I got a nice inconspicuous placement with a tiny scar. Win/win/win

Sometimes they can go lower and deeper without actually putting it subpectoral. They don't put it in the pectoral, but between the two pectoral muscles. Yes, healing is a little longer but it's well worth it. Have the discussion well before your next surgery.

Thank you!

by Kcambridge - 2023-02-04 21:10:24

Tracey_E, I will try that, thank you. As always, it's really helpful to hear about your experience, and thank you for the encouragement.

(And, Penguin, I will keep my fingers crossed for a leadless option!)

Under the muscle

by PacedNRunning - 2023-02-05 20:38:12

Under will stress the leads more and prone to fracture. I'm very active and my doctor wanted it under the skin. Could be the angle it enters  in the vein. Axillary is optimal. Also lead type matters. Some are more prone to fracturing. Maybe they can place it deeper under the skin. That's how mine is and also have leads that rarely Fracture. Perhaps talk to your EP about those things I mentioned. Lead placement/Angle, deeper subcutaneous.   One more thing. Leadless is not ideal if you pace 100%. Stay far away from that one. I'm sure your doctor knows that already. 

Lead type and “under”?

by Kcambridge - 2023-02-06 07:40:03

Hi PacedNRunning - Thank you for your reply. Yes, my doc a while back explained why leadless is not really an option for me. as for your other points: I had no idea that lead type mattered or that they might have given me anything less than the most durable option available -- do you know of any place I can read up on different types so that I know what to request? Also, what do you mean by "under will stress the leads more." Do you mean subpectorally will stress the leads more? Or what do you mean exactly by "under"? Thank you!

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