Very Scared and Confused

Hi All,

I am a 34 year old female that has had a pacemaker since 16. I have had 2 replacements since then and have the original leads I had in 1991. My Dr. told me today during a routine check up that one of my leads is not functioning as it should and as a result the pacemaker has to work extra hard. She said there is "information" interferring at the tip and there is no explanation for it - the interrogation showed no trauma or slippage - again she said there is no explanation. She is recommending that I return in 2 months and if it continues she will add a new lead and replace the PM altogether. My questions are - what caused the lead to go bad?? I can't think of anything that I did. Also, I'm worried about the pain. My first lead implantation was the worst pain EVER, will the new lead hurt this time as well? Also, is this common, should I trust my Doc or go to someone else for an option (I've been with this person for 15 years). Please help.

5 Comments

Bad Leads, Maybe

by SMITTY - 2009-08-10 10:08:23

Hello fgal001,

There are a number of things that can cause a lead to go bad. But with the doctor saying interference at the tip for yours, I will venture a guess that something akin to scar tissue has built up at the point of contact between the lead and the heart wall.

We think (at least I do) of our leads as being in a fixed position and never moving. When in actuality that lead moves every time our heart beats. I became aware of this one time when I was having a heart catherrization and could see the monitor which showed my leads. I could see my leads move with each heart beat. While my leads are "screwed" into my heart wall, there must be an ever so small amount of movement at the tips each time my heart beats. When you stop and think about the fact that our heart beats, say 70 times a minute, that means in one year alone that lead is exposed to about 36.8 millions heart beats. You say you have had yours 18 years so that number becomes about 662.3 million. When I start adding up the numbers I guess I'm most surprised that the leads last as long as the do.

What I'm trying to say is you didn't necessarily do anything to cause this. It just happens to some people. As for the new pain causing as much pain as the first, I woud not presume to be able to answer that one, but I woud not expect it to. As for seeing another doctor, that may provide you some peace of mind. For me I like for my doctors to have lots of experience in whatever field of medicine for which I am seeing the. You say you have been seeing this one for 15 years, and to me 15 years on the job adds up to experience.

As I look back at this I know I haven't answered your questions, and hopefully someone will come along and do that for you.

I wish you the best,

Smitty

leads

by Tracey_E - 2009-08-10 10:08:48

Sometimes they just go bad! I've got a bad one also, no reason for it. I got my first pm in 1993 and still have the original leads. It's not common for them to go bad, but it's not rare either. Most of the people here who have been paced long term have had multiple leads.

Mine is still working but it kills the battery quickly, the insulation is ruptured tho I don't know where or how it could have happened. Picture the a/c running but the window is open- it still cools but the power bill skyrockets. I elected to keep it when I had my last two battery changes but my current one is only 3 yrs old and it's already kaput, so I'm going to get the new lead next time.

If you've been happy with your doctor, I probably wouldn't bother with a second opinion. Nothing you've mentioned sounds odd or questionable to me. But if it gives you piece of mind, go for it

It's normal to get a new pm any time they open us up, as long as they're in there they'll give us the newest and the best.

The pain shouldn't be too bad. Do you know why it was so bad the first time? Everyone's tolerance for pain is different but the first is almost always the worst because replacements are usually done through scar tissue.

Thanks for replying

by fgal001 - 2009-08-10 10:08:54

Thanks Smitty and TraceyE for replying so quickly. Your messages have provided some comfort.

TraceyE - I'm not sure why there was so much pain the first time. My Dr. believes it was because the pocket had to be created, but I always associated the pain with the leads being implanted. Hopefully it won't be as bad. I'm just really bummed that I have to go through this - very inconvenient time.

Lead replacement

by ElectricFrank - 2009-08-10 10:08:55

I'm amazed at how well the leads do. The cardiologist has to fish a lead down a vein into a wildly eating heart and try to fasten the tip onto the heart wall using only an xray image. It is held in place by screwing it into the heart or with a barb type tip. Then there is the issue of any scar tissue or plaque build up on the heart wall.

That's the difficult part. The good news is that the lead insertion process is painless. The veins or internal heart wall have few if any nerve endings so you don't feel it. In my case I had the implant done with only a local injection at the incision site and even though I was wide awake I didn't feel it. The pain you felt afterward was from the process of making the pocket. It is a brutal procedure that can best be described as tearing the skin off a chicken breast. While the injection numbed by chest wall during the actual procedure I could feel the pressure as it was done. And of course it was a bit sore for a day or so after the shots wore off.

In the case of doing a replacement there shouldn't be any need to make a new pocket. The incision from opening the pocket will be sore, but nowhere near the pocket.

best,

frank

pain

by Tracey_E - 2009-08-11 08:08:13

Frank explained it well. Creating the pocket is what hurts, not placing the leads. This shouldn't be much different, pain-wise, than your previous battery replacements.

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