Lead revision risks

I would perhaps seek a second opinion

by Gemita - 2024-09-10 04:20:31

Smopace, I understand your concerns.  From your post and comments, I am unclear what has happened to your father’s pacemaker leads and how his doctors intend to fix the problem.

A lead revision involves repositioning a lead within the heart muscle, or replacing it with a new lead. The old lead may be left in place or removed and a new lead added.  A lead revision may be required when a lead is not functioning properly.  This could be because it has moved from its original position, or it may have developed a fault like a fracture.  

Revising or replacing the lead means the pacemaker can then function properly, although clearly your father is not having any symptoms at present so I can only assume they have been able to adjust the lead settings to help overcome any faults, to keep your father symptom free.  However by increasing lead voltage, for example, this would drain the device's battery more quickly which is why they might be looking for a permanent solution to fix the problem?

What will definitely introduce more troubles in the future is to do nothing “if there is a problem”.  If you trust your father’s doctors, I would go ahead with their recommendation.  

I am unclear what the 300+ short interval noises since 2022 represent.  The fact that your father is not symptomatic is a reassuring sign so far, but I am assuming that this may not continue to be the case if no action is taken.  On the other hand there are many causes for lead noise, so perhaps in the absence of symptoms and a confirmed diagnosis for the lead noise, a second opinion might perhaps be worth considering?

Depending on the procedure required, serious risks could include bleeding or bruising from puncturing the heart or tearing a blood vessel, infection, a punctured lung, build up of fluid around the heart, blood clot formation.   It is important that your surgeon has experience with lead revision or extraction.  When done by an experienced surgeon, lead revision/extraction can be safely performed with good success rates.

I wish you both all the very best

Advice

by piglet22 - 2024-09-10 04:26:15

Go with what the clinicians say.

They know the risks.

Though just a generator change, my aunt had surgery in her late 80s, successfully.

Probably, the sooner it's done the better. If there is unexpected noise being picked up, it could get to the point where it becomes difficult to detect the pacing signals in the noise background.

I hope it works out for you all.

leads

by Tracey_E - 2024-09-10 10:20:02

I would ask more questions, starting with exactly what do they mean by revision. A lead that's been in since 2017 can't be repositioned/revised, it would have to be extracted. Extraction is a much bigger surgery done by a specialist.  If he has room, they could cap off the bad one and add a new lead. If they can do that, which they can verify by doing a venogram (iv with dye in the cath lab), that would be the easiest solution. 

If the battery has more than a year left, and he feels good, I would clarify that the noise isn't dangerous and put off a decision until the battery goes. Some lead noise needs to be dealt with, some does not. I had lead noise for more than 5 years before the battery wound down and we dealt with it all at the same time. 

Lead noise

by smopace - 2024-09-10 14:41:38

Thank you very much for your response. The noise mostly introduced by arm movements.  The doctor told us they will not do lead replacement instead adding a new one if the patient is over 80 years old. The noises are all short intervals, that is why my father does not have symptoms. From Metronic report, "Sensing issue: 329 short V-V intervals since Jun/17/2022, 1:31:01 PM. Check for double-counted R waves, lead fracture, or loose set screw.", it needs to consider taking some action. 

Inappropriate Mode Switching

by Flo - 2024-09-10 15:26:30

My Metronic reports say a similar Observation as your Dad's. My EP called it Inappropriate Mode Switching due to lead noise  and did a pacemaker adjustment by turning the sensing down. Mine can be brought on by leaning back in a chair. The Adjustment helped somewhat but now I am having  a flutter and the EP talked about a cardiac ablation.  I was hoping for futher investigation into the lead issue. Sorry I don't have an answer but interested in your experience.

sensing threshold

by smopace - 2024-09-10 16:12:17

Thanks for your reply Flo. My father had the issue back in 2021 during pandemic, it was recorded as more than 600+ short interval noises. Then the technican increase the threshold. The noise decreased a lot. From 2022, it accumulated to 300 again.  The doctor is aware of the trigger of the noise. 

Hi with a hearty welcome

by Lavender - 2024-09-10 20:37:25

I like the idea of a second opinion. 
I have a lead that's not optimally placed and my voltage is turned up in that one. We are awaiting the battery wear down. I will have a new pacemaker and lead revision or replacement in time. Part of me wants it done yesterday but part of me says that I feel fine so why stir things up until we have to🤷🏼‍♀️

lead revision

by KF - 2024-09-11 20:44:12

My interrogations are every 90 days remotely. I hadn't seen my doctor since implant April 2020. Bradycardia. I received a call this pastFebruary to come in and I am going next week again for followup. My report stated the following:* Abrupt rise in atrial lead impedance and threshold In Dec 2023 suggesting microfracture of lead. *Sensing of P waves is preserved so AV synchrony is preserved. * Receives minimal A pacing (4%) so no need for lead revision * Intrinsic conduction has returned and then he stated he switched something in the pacemaker. 

I don't know what to think, I'm 74 male and I'm swimming laps for 45 minutes straight doing 700 yards in that time. I'm hoping that the pacemaker and my heart are ok but I'm nervous about next weeks visit. I thought they just switch out the pacemaker and leave the leads forever, after the 12 years,  I hope!