Dislodged Leads

Hello everyone. My 37 year old husband had a pacemaker put in on 11/19/08. He had some complications a month later and on 12/23 he had a second surgery to reattach the a-lead. This weekend he has started back with the same complications, jerking of the chest and shoulder. It is back to the dr tomorrow and seems like it will be the same thing because the symptoms are exactly alike. He has followed the drs directions to a T. Still in the arm mobilizer. I just wondered if anyone knows why this would come loose twice and if this has happened to anyone else. I really appreciate any help you can give me.
Thanks

12 Comments

where?

by Tracey_E - 2009-01-04 04:01:23

Is it dislodged in the heart or has the lead come out of the pm itself on the other end? There are some rare cases where people can't keep them attached in the heart, it is more a compatibility issue with the person and the type of lead end than anyone doing anything wrong. But it sounds like it's coming out at the device?? I've never heard of that. Regardless, I would insist on a second opinion before letting the same doctor have a third try at it. New eyes may catch something different.

leads

by Pookie - 2009-01-04 05:01:20

Hi

I too had my atrial lead "float" and not anchor itself twice too! In the end I demanded someone else deal with this as this was going to be my 3rd surgery all within 10 days of initial surgery.!!

In the end, a cardiologist used a lead with a different kind of end or tip...one that was sort of like a screw and it finally anchored itself into the heart.

Discuss ALL the possibilities with whomever is going to do your husband's surgery and personally, I'd be asking for a 2nd opinion. The jerk that tried the first 2 times on me was just a vascular surgeon, that is when I demanded a cardiac surgeon.

Tracey brought up a good point...which end of the lead is not working or staying attached? Mine was the end of the lead that goes into your heart, not the end that goes into the actual pacemaker.

Good luck & keep us posted.

Pookie

Loose from the heart

by a worried wife - 2009-01-04 07:01:50

The lead did come loose from the heart and not from the pacemaker. I should have specified that. The surgeon that did the last 2 surgerys did not mention another lead. He said if it came loose again that he felt we should remove on lead and only have a single chamber. I have already spoken with our regular dr and we are going to request a cardiac surgeon. Thanks for your comments. It makes me feel much better to know there is another kind of lead that may help us.

Leads

by a worried wife - 2009-01-04 08:01:18

I am still amazed that the other type of lead was not mentioned to us. Tracey stated that it is easy to turn off the other one. The surgeon said he would have to go back in and remove it. Have any of you had this done. The lady from medtronic did mention turning it off and leavig it but he said we couldnt since it was loose. They did say he would be okay with only one lead but is safer with two. I was also wondering how long it usually takes to get your energy back after the surgery if everything is working correctly.

leads

by Tracey_E - 2009-01-04 08:01:24

There are two types of ends on the leads, a screw or a barb. It may be time to try the other kind! I'm glad to hear you are getting a different surgeon. It's usually very simple, but unfortunately not all the time. I'm sorry your husband is that small number with complications.

Does he need both leads? If he doesn't need both, it's easy enough to turn off the other one. I'd definitely want another opinion before making that decision!

A cardiac surgeon has done all of my pm surgeries, also. I see more people here who have an EP or cardiologist do it, but my doc has always referred me to the cardiac surgeon. I am 42 now, I got my first pm when I was 27 so I've been through several batteries by now!

If you or your husband have any questions about being young and otherwise healthy with a pm, please don't hesitate to ask. You won't meet many of us on the street but there are a bunch of us here living full, perfectly normal lives with our little titanium buddies.

loose

by Tracey_E - 2009-01-04 09:01:07

There are people here who have one hanging lead loose in there that is turned off and they get by fine with one lead. It is easy to turn one off, it may or not be safe to leave the lead where it is. I guess it depends where it's "hanging".

Most doctors have the one kind they like best and that's what they use. It's not unheard of to have someone who doesn't do well with one or the other, but it is rare. Most can use either one, it's not something the surgeons usually have to take into account so it's not surprising they haven't mentioned it. I only knew about it because I've chatted with Pookie and that's what happened to her. ;o)

IF everything goes well and you don't have side effects of meds and other conditions complicating things, it takes on average 4-6 weeks to get your energy back.

TraceyE

by a worried wife - 2009-01-04 09:01:30

Just wondered how many pm you have had during those years. When they tested my husbands to see if it was loose they checked to see how much it was being used. The good lead shows being used 87% of the time and gave an additonal time of 6 1/2 years. That was only a month in. The manual to his says it has pacer leads? Are they all pacers? He never knew he had heart trouble until August of 2008. This is all nw to us and really confusing. Thanks for all of your information.

four

by Tracey_E - 2009-01-04 10:01:03

I'm on my 4th device! I should be getting a lot longer out of my batteries but I have an impeded lead- that means it has a kink that broke through the insulation so the voltage has to be cranked up high to get the signal through. I made the choice to not get the lead replaced. Battery replacements are very easy, I'd rather have them more often than deal with getting a new lead before it's necessary. I pace nearly 100% of the time with the ventricle, usually about 4% with the atria.

5-7 years is average for one battery. They can tell him each visit how much time is left, but don't be surprised if the numbers jump around! Each time they change the settings, the number will change because it's just a projection based on the current settings. They may tweak the settings several times before they are just right for him. The settings they send us home with are great for a sedentary octogenarian, but not always right for someone younger and active.

Some people have ICD's - defibrillators- along with their pacemakers. But yes, all pacers have pacer leads.

Turning off the lead

by ElectricFrank - 2009-01-05 01:01:45

Even if atrial pacing isn't needed, the lead provides sensing information that is needed by the pacer to be able to sync the ventricles to the atrium.
Without the a-lead the pacer would have to be set to pace the ventricles using rate response which is not as natural a situation as atrial sense/ventricle paced mode.

So I would certainly try to get a working lead attachment. Keep in mind that the surgeon isn't the one having to contend with less than comfortable pacing, and has a financial interest in not spending "warranty" time fixing it properly. Too bad we have to contend with this sort of thing, but modern corporate medicine is a bottom line business.

frank

I have recently had lead removed

by kiwi - 2009-01-05 07:01:19

Hello,
Only a few months ago, I had a dual pacemaker implanted and a few weeks later, the ventricular lead detached from my heart and then pierced the tip of my heart - apparently a very rare occurence.

It took a few days and alot of pain before they realised my lead had come away from the heart. They couldn't find anything wrong when I was readmitted to hospital, but I had constant referred pain in my neck and shoulder, was feeling unwell and it wasnt until I started getting zapped in the chest that they finally decided to do a second CT scan and interrogation of my pacemaker and diagnosed the problem. Apparently this was only the 2nd time in 6500 implants that this has occurred.

I was extremely lucky that they were able to extract the lead without damaging my heart, and thankfully I did not require open heart surgery. My leads are the corkscrew type end.

I am now only atrially paced and pacing at 40 percent. They did consider replacing the ventricular lead but decided to leave it for now as my atrial pacing is doing its job.

If in doubt, ask for a second opinion and always trust your instincts if you suspect something is wrong.

New lead

by chip - 2009-01-05 10:01:50

There is a new lead out from Medronics that is tined. The lead is placed in the coronary sinus and can pace either the atrial or ventricle. The tines are several inches from the business end and are secured to the artery wall (the lead end floats free in the artery)

I had a lot of problems with atrial pacing until this new lead solved them for me!

If he continues to have problems ask your doctor about it – it has given me my life back.

Lead came loose

by sand dollar - 2009-01-05 10:01:52

Hi, I just had my pacemaker put in the 17th of December. The 18th they tested and told me one of the leads didn't stay in the heart so I had surgery again the 18th. My doctor was a cardiologist, not a heart surgeon. It is my understanding that heart surgeons don't like to do these simple little pacemaker implants but to me it wasn't just a simple little thing. Having surgery twice in 24 hours was not fun and it has made recovery slower. My leads were the corkscrew type but the doctor had trouble because he said young hearts are softer and harder to get . After reading all the responses, it seems that staying on top of things that don't feel or seem right is best. We are our own best advocates. To the doctors it is business as usual and "next". I hope your husband does better soon. I am only 52 so am bouncing back pretty good considering. I am not lifting my arm above my shoulder for 6 weeks though, don't want to pull our my lead and risk a 3rd surgery.
Vicki

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