Lead problems

My son received his 1st pacer this past April to treat heart block. After just under 4 months his vetricular lead is having conduction problems. His doc says it is likely scar tissue around the site where the lead enters the heart that's insulating the electrical connection. They want to remove the existing lead and put in a new one. He has the type with a helical anchor. On line, I found a patent for a modified version of this kind of anchor that stated this scarring is a known problem with these helical sysems.

Lead extraction is worry-some enough plus the added concern that the new one will do the same scar up the same way.

Anyone here heard of this or have any advice for us.

I've been trolling this forum for a while now, thought it was time to sign up and be heard. Thanks for all of you that post with advice, questions or a comforting ear to bend.

Bluesfish

8 Comments

EDIT

by Bluesfish - 2007-08-13 01:08:23

Forgot to mention, my son is 14.

Hi Bluefish

by riley - 2007-08-13 05:08:54

I can only tell you that the same problem occured with my PM that I've had only 1yr. An attempt was made 3mos ago to replace my lead. After 1 1/2 hrs. of surgery my EP Dr. gave up. There was so much scar tissue he couldn't remove the old lead or find a good vain to insert a new one. He claims this usually is seen more with ICD's and not PM's. My next option is to have a whole new system put in on my other side. Since I'm only using my PM 4% of the time we're taking a wait and watch approach right now. If the capture rate declines more I will be having a new system put in soon. However, this time my EP said he will screw the leads into my heart.

Riley

Comforting Ear Available

by hooimom - 2007-08-13 10:08:46

Hi Bluesfish,

I am glad you finally signed up to share with us. I can't really give much information or advice since I don't know much about that type of lead or anchor. but I can offer a comforting ear. I have two teenagers of my own. They don't have pacemakers, but we have dealt with medical issues over the years and I know how scary that is as a parent. My heart goes out to you and to your son. It does get really frustrating when you hear that something has been put in your body when there is a known problem! No one should have to go through this at 14. Feel free to private message me if you want to vent to someone.

Michelle

Hi, Bluesfish,

by Gellia2 - 2007-08-13 11:08:22

I had the very same thing occur with my first pacer. The lead became scarred over and lost "capture". Because mine had been in there for a number of years, I wound up with a completely new system. The key was they used leads with small screws on the end. They were screwed directly into the heart wall thereby eliminating the chance of scarring over. I have now had these same leads for 25 years and they are still functioning 100%!
Maybe you could find out about them. My pacer and leads are manufactured by Medtronics.
Best of luck to you!
Gellia

replacing a lead

by bambi - 2007-08-14 08:08:48

Hi Bluefish,
The above two postings really give you an idea about the different outcomes extracting and replacing leads can go. I had to have both my leads extracted and replaced last summer. The latest method of extracting a lead now is to use a laser sheath. This instrument burns away the scar tissue that has built up around the leads. This is evidently much safer than the old way of more or less pulling and yanking them out! However, there are still risks, including rupture of the SVC, and/ or the heart muscle itself. I would recommend that if you all decide to go ahead with the extraction, that you find a Dr. who has used the laser sheath method many times. Go ahead and ask him/her how many of these procedures they have done, and how many have been successful. Sometimes the Dr. will find the scar tissue too tough to get through, and give up the attempt because of the danger of rupture, as in Riley's case. The extraction of both my leads was successful. Anyway, feel free to ask any questions you may have, and welcome to pacemaker club!
Bambi

Screw leads

by tbe7 - 2007-08-15 03:08:32

My screw type leads were put in 15 years ago
and still work fine.

Update

by Bluesfish - 2007-08-27 02:08:44

I’d like to thank those that posted with comments and support and also update you on our situation. Perhaps this will help someone else down the line.

Spencer’s (my 14 year old) leads are from Medtronics and are a relatively new model. Our Pediatric Cardiologist has used them some 30 times, they are much thinner than previous versions and they do have the screw type electrode. He’s been very pleased with them and had zero difficulties until now. Anyway, Spencer was prepped for surgery Friday morning and wheeled into the O.R. Pryor to putting him under they ran the programmer to get the latest data. Instead of the voltage required to get his heart to follow the PM increasing from the last scan (as expected if the diagnosis was true) it had decreased. Our Dr. immediately called Medtronics and talked to an engineer there. What we were told is that with other style leads they see the required voltage steadily increase after insertion and after about 4 months it drops down to a normal level presumably due to inflammation around the site. Once the tissues normalize, so does the required voltage. Since our Dr. hadn’t witnessed this using these new small leads it wasn’t considered. Also with these small leads the window of opportunity to remove the leads without risk of tearing from adhesion to the vein walls is increased from 4 months to 6 months with these leads. His surgery was cancelled and we will be going in for a scan every 2 weeks for a while to monitor the situation. We expect that the voltage required will continue to drop and normalize but we have to wait and see.

Thanks again to all responders..I'll keep you posted of any new developments.

Bluesfish

In a similar situation

by john1945 - 2012-08-24 07:08:33

Hi Bluesfish,

I was just about to post a request for information on a similar situation I find myself in so thank you all for the information on this subject. It is nice to know that others are coping with these problems and you are not alone.

I had a Medtronic Protecta XT ICD implant on the 10th July this year and went for my first check-up yesterday. There was a air of supressed "panic" when they looked through the downloaded information and I was informed that the Medtronic ventricular lead had a high resistance. I was whisked down to the lab for an x-ray. This confirmed that the lead was still in the original place. The technicians consulted the EP Doc by phone and he told them that I was "still in the 3 months acute phase"! sometimes the resistance goes up then down during the first three months. They did a "work around" with the ICD, told me I was quite safe and I have to go back in a months time for another check.

My lead is a Medtronic 6935 (65cm) I would be interested to know what lead you are talking about Blusfish.

kind regards John1945

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