Advice please!

Hello all! Hope everyone is doing well! So for the 4th time, my leads have fractured, leaving me needing surgery once again to replace them. The last time this happened (3 years ago) the doctors left the fractured lead in me and just put the new one in next to/with it because apparently taking out the fractured one was too risky. Since I have had to have so many surgeries in a short amount of time (from the continuously fracturing leads) I have a lot of scar tissue built up where my leads are, making the surgeries much more dangerous, because I might have uncontrolled bleeding during extraction and they will have to crack open my chest. THIS TIME, however, they have decided to take out ALL of my leads and replace them. Since this is worse than the last time, I am terrified that they will have to do an open heart surgery. Has anyone had to deal with this before? What were your experiences like? I am a 25 year old female Federal agent with a very active job; I would hate to see something like this ruin my career! Any advice or stories, even negative ones are welcome right now. I'm slightly panicky. Please and thanks, and God bless!

Nervously yours,
Jo

10 Comments

Iris

by Iris Pennock - 2013-06-06 02:06:14

Hi Jo;

I had open heart surgery. 10 years ago. I was 75 years old then. It went very and you are much younger
and will recover quicker. It is a tough surgery as I remember ,I had very good care and rehab went very well
I have had 10 years of good living and then had the pc
implanted a few weeks ago.It happened so fast I didn't have time to consider all the options but I hope my energy
will return to make this all worth it.Good luck and God Bless
Iris

Hi Jo!

by Chels - 2013-06-06 02:06:26

I just posted this in another topic so I will try not to be so long winded..I might just send you a private message!

I am 28 years old and just had this procedure done a couple weeks ago. I was so, so nervous before hand after googling and reading that the cardiothoracic team would be in the room just in case they needed to crack me open. I have two small children, was writing letters to them in case I died, etc. I'm not going to say it's not worth it to worry, because I tend to think we need to prepare ourselves for what is entirely possible, but I will say that you need to have faith in your doctor. Everything went smoothly for the most part. The 22 year old lead fell part during extraction so surgery went much longer and was more risky than he had anticipated. He ended up leaving a small piece of it in. I did lose a lot of blood but not because of the extraction itself, but due to they used my femoral artery to pull out the lead and the artery wouldn't stop bleeding when they were done. This was not a huge deal as they had the vascular surgeon on stand by in case it got out of hand. I did get two units of blood but they eventually got it to stop bleeding and all was well.

Can I ask, have they said why your leads keep fracturing? Is it the manufacturer? You can message me if you want to know more about the procedure.

Chelsey

leads

by JoFosqk226 - 2013-06-06 04:06:04

originally, I had the Fidellis leads... that didn't turn out well. Then I went to medtronic, then St. Jude.

leads

by Chels - 2013-06-06 04:06:04

What company are your leads? I am also very thin and small (although do not have a physical job but was active and in sports my entire childhood) and have never had a lead fracture. Have all of your leads been the same manufacturer? Have they discussed trying a different kind?

Thanks!

by JoFosqk226 - 2013-06-06 04:06:53

Thanks everyone! This does make me feel better to know you all have gone through this successfully.

Chelsey: They don't know the exact reason the leads keep fracturing. They think it has something to do with my size and activity level. Their best guess is because I am very thin that the wires don't have much protection under my skin and with my job I am constantly tackling people and I have to exercise a lot. The doctors aren't sure this is the reason, but its the best one they could give me.

lead extraction

by bambi - 2013-06-06 10:06:19

Hi Jo,
I haven't been on the forum in a few years, but your story jumped out at me. I had a dual lead extraction in 2006 due to an almost complete blockage of my superior vena cava caused by scar tissue built up around the leads. I was also warned about the risks involved around this procedure. To put your mind at ease, I did very well, and did not have my chest opened. The Dr.s, my cardiologist and a thoracic surgeon, successfully extracted both leads, my SVC was ballooned, a stent was placed, and I had new leads put in. They have come a long way in lead extraction in the past few years with the use of laser surgery. Yes, this procedure does have serious risks, but as with any surgery, the Dr.s must paint the whole picture. You are so young, and probably pretty healthy, so you will most likely do very well. If you have any questions, I will be happy to answer them!
Bambi

Where do they fracture?

by donr - 2013-06-07 07:06:35

Jo: I had my first lead fracture after about 4 yrs. I don't tackle people, nor do I exercise a lot. The lead just fractured, no reason ever discovered or even offered by my EP.

Now there are fractures & what I would call a shatter. Fracture to an engineer is a mode of failure where the break is very sharp with an end that is not stretched out at the point of breaking. A shatter is where an entire section breaks up into many pieces - like an ice cube or a hunk of glass when smacked w/ a hammer.

Actually, a fracture is described as a "Brittle fracture," usually caused by constant back & forth sharp bending till the material just suddenly breaks at the bending point. It also means that the wire is NOT flexible - namely that it breaks like a crisp bread stick in an Italian restaurant. If this is what is happening, it means that you have rec'd defective leads, because they are supposed to be flexible.

There is another plausible explanation - the human body chemical makeup is extremely corrosive. Perhaps your body chemistry is such that your body fluids get between the polymer sheath covering the metal parts of the lead & leach out of the stainless steel outer conductors some of the alloying metals that give the stainless its properties.

Have the fractured leads all broken in the same location, relatively? Like very close to an end where the polymer sheath ends & hopefully seals to the stainless? MIne fractured in the vein & the end came right out & my EP gave it to me as a souvenier.

If you have had multiple leads fracture & were by different manufacturers, the only COMMON variable in all cases is YOU & your particular body chemistry. As an engineer, I'd start looking there for the answers as to WHY.

Don

Don

by JoFosqk226 - 2013-06-08 01:06:56

Yes, you are correct, it IS me. The question I haven't been able to answer in the past 8 years is why. I can't understand how I can break something that is inside of me. I am, however, a chemistry buff and was biology and human genetics major in college, and I am interested in your body-chemical make up theory. Unfortunately in my case it's not true. Blood work was done and my acidic levels were completely normal. I have tried many lifestyle changes after each surgery, yet I haven't seemed to pinpoint the exact cause that keeps ruining my box and its strings. Oddly enough, each fracture has occurred in different spots on the lead, which destroyed a few of my theories. I will ask for my lead as a souvenir this time though! ;) Thanks for the comment!

Very Interesting case

by donr - 2013-06-08 07:06:53

Jo: You must at this point slip out of the box & look at it from a different viewpoint.

There are three diagnostic approaches to the problem:

1) Occam's Razor - which states that the simplest explanation is most probably the correct explanation. Therefore start your exploration/analysis w/ the simplest hypothesis & work your way toward more complex hypotheses.

2) Sherlock Holmes Approach - which says eliminate the impossible & whatever is left over, no matter how improbable HAS to be the solution to the problem.

3) Don's theory of failure - which states whenever something goes wrong, examine that which was worked on last, first.

Sounds like you have examined the simplest solution - your body chemistry & it is normal - or as the sawbones are apt to say "Within Normal Limits" (WNL). But "Normal Limits" can be quite wide for some measurements. Are your acids at the high end of the WNL spectrum? My first thought was acid levels - but what about the rest of your electrolytes? K, Na, Mg, Zn, etc. There is more to "Corrosion" than acid levels. All you need is an acid bath w/ the right concentration of some other ion to cause a "Plating" effect - just as in Chrome plating or copper plating or silver plating. Every water heater has a Mg electrode in it to protect the rest of the system from corrosion - Mg because it is the most chemically active metal that just doesn't spontaneously react w/ water, like Li, Na, f'rinstance. (Remember the old college prank of tossing a small chunk of Na into a toilet, flushing it quickly & running like Heck to avoid the explosion.)

Ok, so you need another electrode to make this happen. You already have the voltage/current source in your device battery. Do you wear any jewelry all the time? Like a stainless steel watch case? A necklace? A ring/rings? Perspiration (I know that ladies don't sweat) can be a marvelous conductor. To make a lead fracture does NOT take a lot of leaching from the stainless to change its physical properties.

As you can see, I am working my way UP the complexity chain of hypotheses.

As to what was fixed last - Did your FIRST lead fracture? Was it left in your body? If from a different Mfgr, it could well be a different alloy of Stainless, thus setting itself up as the other electrode for the plating effect. At this point, you would have to know the composition of the various stainless steel components of the leads.

In all these hypotheses, it makes sense to focus on your body chemistry, since that is the common factor in all the lead failures.

We have been talking "Fracture" all along here. Could it be that the mode of failure is NOT the engineering definition of "Fracture," but something else causing them to fail? I doubt that any MD has examined your lead ends & determined that the failure was truly engineering fracture. That would take a very powerful microscope & some special equipment & talent in the field of metallurgy.

I really doubt that you could have caused the lead failures. They are built to be flexible. After all, inside the heart chambers they get whipped around all the time while the blood flows across them.

Unless you are tackling steel pipes, most legs have a little give to them.

Yours is an interesting case. Wish you well in finding out what has been going wrong - it may well be worthwhile to take all the broken ends & get them to a metallurgy lab for detailed analysis. I'll betcha that some Metallurgy PhD candidate would love to get his/her teeth sunk into this as a dissertation subject & worry it to death. Try MIT in Boston for a candidate to do the job. Under those conditions, it should NOT cost you anything.

Don

You are not alone!!!!!

by donr - 2013-06-09 09:06:40

JO: This just popped up in another thread a few minutes ago. It's by Donb (The Other Don) & it's in a a thread called
"Turning my PM off!" About three or four down from top at 8:44 PM, EDT. His comment is way down toward the bottom of the thread.

He has had leads continually go south on him because of corrosion. In the Hosp right now awaiting surgery tomorrow.

He writes good commentary & analysis. Could be a good resource for you.

Donr (The other Don, also)

You know you're wired when...

Your signature looks like an EKG.

Member Quotes

I feel so blessed to have this little gem implanted in me. When I think of the alternative it is quite overwhelming sometimes.