Lead preservaion

Good morning and thank you for this great web site. This is my first post and would I certainly appreciate any feedback.

I have 3rd degree AV block, pacemaker first installed in 2001, a replacement implanted in September of this year. The incision opened within 2 or 3 days and will not heal (no infection, evidently poor skin quality). The device is exposed and I am scheduled for a device and lead removal to be followed by a new implantation on the right side of my chest.

I have discussed the possibility of lead preservation with my cardiologist (replacement of the device in a different location on the same side, rerouting of the leads to the new device). He refuses to perform this procedure and advises me that there is NO ONE in the United States, much less Southern California where I live, that would do this.

I know that the most aggressive and conservative procedure is complete removal of device and leads. But I wonder if anyone here knows of lead preservation being performed under the circumstances of no infection (contaminants on the device but no overt infection)? Any "leads" (pardon the pun) would be most helpful.

Thank you.

Bill

7 Comments

No Leads on Leads

by bobad - 2008-10-23 09:10:34


Bill,

We are in the same boat. In my experience, they will not leave those leads in and re-use them.

Apparently, based on case studies, doctors feel they must treat that type of wound as an infection. Even with no overt signs of infection including negative cultures, they like to yank out the leads to lessen the possibilities of devastating endocarditis.

I asked the same question, and my doc wouldn't even entertain it. He pulled the whole thing and implanted a new PM on my right side. Not only was it terrible on the right side, but it refused to heal. Doc doesn't know if I have colonization (a low grade infection) or have developed a sensitivity to the PM materials. In that case, the doc has no choice but to treat the case as though there is both an infection and an allergic reaction.

I would be interested to know what brand PM you are using. Mine is a St. Jude.

Please keep us informed. There are now at least 3 of us that are having the same type of problem.

Lead reuse

by billpalmer - 2008-10-23 10:10:37

Sounds like I'm not alone. I'm glad to hear that but I do feel badly that others are having the same issue. By the way, my original PM was St. Jude, the replacement is from Medtronic. I have no problem with the device itself so far (7 weeks or so).

Yes, you're correct, the profession does treat the incision exposure of the PM as an infection even though one might not have any symptoms as in my case. Nevertheless the device (and potentially the leads) have been "contaminated" and leaving the leads in place in turn might eventually lead to lead infection and transmission to the heart.

I do have a study from The Annals of Thoracic Surgery describing a series of lead preservation procedures performed in Japan during the 1990 to 2001 time period. The criteria for not performing the procedure were bacteremia, endocarditis, or purulent material within the lead insulation, none of which I have. Nor do I have actual pocket infection....yet. In spite of this and my arguments for lead preservation, my cardiologist refused to even consider the procedure. I hate to say it but I think there is a legal fear going on here.....just mho.

Did you have more difficulty on the right side than with your original PM?

Thanks for responding.

Bill

leads

by anette - 2008-10-23 10:10:38

Read onthe internet:
PACEMAKER LEAD REMOVAL and another article:

PACEMAKER LEAD COMPLICATIONS;this one
www.heartinl.com
Anette

Forgot to Mention

by bobad - 2008-10-23 10:10:44


BIll,

Apparently, low grade infection and /or sensitivity to metal is causing tissue erosion. When you have tissue erosion, chances of healing are poor.

According to my case, I'm worried that an implant in your right side also won't work. I certainly hope I'm wrong!

I'm totally without a PM now, awaiting my original left side to heal completely. It's about 95% healed now. My right side was a large gaping wound that my wife had to pack with sterile gauze soaked in Bunnell's solution every night for 2 weeks. It's looking better now, but healing slowly. I think I'm almost out of danger for infection now. Hope yours can be sewn up, and you don't have to go through that packing ordeal.

I'm seeing my doc today, and apparently you are in hospital now. I will keep you up to date on my case; please keep me up to date on yours.

Best of luck in finding a solution to your problem,,,

Bob A.

Moving pacemaker without lead replacement

by billpalmer - 2008-10-24 09:10:41

Frank, thanks very much for the suggestion. I never thought about calling the pacemaker support line, will do that today.

I know what you meaan about hating to see you coming....I don't think they are used to having informed, questioning patients...but it is our body and our life that is at stake. not theirs.

I'll post back re my dialog with the manufacturer.

Bill

Moving pacer without lead replacement

by ElectricFrank - 2008-10-24 12:10:47

I recall seeing something about a procedure where the existing leads are just extended to a new location. This has the advantage of not needing to remove the old ones from the veins and heart which is a risky procedure. As long as you aren't concerned about cosmetics there is ample room on the left side for an alternate location and that shouldn't be any more likely to have infection problems. The only reason I can see for removing the leads is if they are the source of the infection.

You might try contacting the pacemaker manufacturer support line and explain the situation. Tell them you would like to explore alternatives and ask for a list of cardiologist in your area. My suggestion would be to concentrate on cardiologist's who do a lot of implants. While cardiologists aren't the best when it comes to programming a pacer they generally are more experienced at the surgery. Also, ask about having a prophylactic injection of antibiotic before and after the surgery.

I'm an old duffer..78 and looking at replacement in the next year or two. I'm already exploring the options and trying to get ahead of the game. They hate to see me coming because I tell what I want.

good luck,

frank

Interesting development

by billpalmer - 2008-11-21 04:11:12

As I first posted, my pacemaker incision had opened, exposing the pacemaker surface. The opening took place during the second week of September and my cardiologist insisted that I must have a removal of the entire system and insertion of a new system via the right side of my chest.

As of today (November 21), the pacemaker incision seems to have completely healed, there is no sign of infection, no pain at the incision site, no fever, no physiological signs of infection. My plan is to undergo a program of blood monitoring for the next year or more. Meanwhile I have cancelled the scheduled pacemaker removal and replacement procedure.

If anyone is interested in the details, I can provide them here but in brief I undertook an intensive self-administered therapy involving careful cleansing, megadoses of Vitamin C and Lysine, early irrigation with Peroxide, topical application of an anti-bacterial ointment, and a declining dosage of antibiotics (Cephalexin). I consider this approach far less risky thanthe surgical procedure.

Bill

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