Left Atrial Lead

Does anyone have one? My doctors are talking about moving my atrial pacing to the left side. When I had the pacer put in a month ago it took almost 3 hours because they couldn't find a spot that would take in the atrium. They finally found one and when I left the hospital the lead was looking fantastic. Now It's been 5 weeks and every week the lead has gotten worse. I randomly have episodes where it's not capturing and they keep uping the voltages. Now I am to the point where my battery will not last more than 4 years. I am 24; that's a problem.

Anyways; an option is putting the a-lead in the left and keep the ventricle in the right (it's just there monitoring it paces less than 2%). I wanted to know if this actually works and if you feel fine. I am so sensitive to feeling how my heart works. I got the pacer because I couldn't handle the feeling of junctional rhythm although my heart rate was fantastic and it responded well to activity.

Thanks!

5 Comments

It's hard

by jessimay - 2012-07-24 09:07:11

to keep waiting when you feel like you can't do anything. I get so out of breath from moving and I get a choking feeling here and there. Im in the office every week getting an adjustment. I usually feel fantastic for a day or two after then back to square one. Waiting is a fantastic idea but at the same time getting it done and over with sounds fantastic. I just can't see the end of the tunnel and I know waiting is always a better idea but it's frustrating.

As for opinions I have three. They all say the same. I have my main EP in Jersey, then one at NYU who trained my EP and then an ego freak at Mt. Sani. They've all operated on me, I get around haha. Another opinion wouldn't be a bad idea but like you said no doctor wants to go against what another one said. I am also at the point where I am done explaining everything.

I'll probably call tomorrow; since last night I can't move with out feeling like someone is stepping on my throat. It's just nice having people to talk to and knowing you're not alone.

Thank you

by jessimay - 2012-07-24 12:07:27

I go back in a month to see what's next. He wanted to give me another month of healing. I just feel like absolute crap and very pessimistic. I have been on such a downhill since the implant. We did not talk about how the left lead goes in. I just assumed it was like the right side. The doctor and I both know an epi lead is not an option. I had an epi ablation last december and had severe inflammation and pericarditis; a heart mri showed that it turned into scar tissue and theres no room to even get up there. I do not think (or hope) he would mention a lead there if that was the only way; but who knows. The wait and see game has gotten to be frustrating.

Epicardial lead on the left atrium

by golden_snitch - 2012-07-24 12:07:39

Hi!

I have a lead on the left atrium, but an epicardial one so it's not inside the atrium, but on the outside. Feels fine and works well. How are they going to get your lead in there? I mean when they need to get into the left atrium during a heart catheterization, they have to puncture the septum between the right and left atrium. Cannot imagine that this is an option for a pacer lead, too, but maybe it is? If epicardial is what they would have to do, I'd not rush into that after just a month as it is a much more invasive surgery plus epicardial leads are known to last not as long as endocardial leads.

I'd probably rather take the short battery life than having the lead moved after a month. The first couple of weeks or even months, the lead needs to heal in, and the tissue is still a little inflammed, and so the threshold is higher. After about three months the threshold and accordingly the amplitude can usually be turned down a bit. So I'd give the lead a bit more time, but that's just what I would do.

Best wishes

Inga

Two thoughts...

by golden_snitch - 2012-07-25 04:07:07

Hi!

Why don't you just take a betablocker or verapamil to suppress the junctional rhythm? I have been doing that for years. It works. And if the junctional rhythm is the only reason why you got the pacer - I would guess that the pacer is set at a higher rate than the junctional rhythm, so that it overdrives that rhythm?-, then that could be a solution, at least for now. Might be better than having another surgery.

I have scarring of my pericardium, too (due to pericarditis), but that was no problem at all for epicardial lead placement. Even had an open-heart surgery where they took a patch from my pericardium to reconstruct my superior vena cava. For the epicardial lead placement they just have to cut through the pericardium to attach the lead to the heart muscle. I have never been told that the scarring would complicate things. Had pleurisy shortly after the lead placement, but that's from what I have heard a common thing after surgeries like this. Just saying, if really, really needed they could give you an epicardial lead, too. But you need a cardio-thoracic surgeon for that, not an EP. EP might tell you it won't work, but this is the surgeons domain, and I'm pretty sure a surgeon would say it's possible.

Thanks!

by jessimay - 2012-07-26 07:07:23

The problem isn't the junctional. My lower limit is set at 75 to override which isn't bad. I have the pacer for that and long pauses.

The problem is my atrial tissue decides when to capture the impulses. When it isn't working I guess I am feeling the junctional. It's horrible when you flip flop between pm sinus rhythm then junctional every few seconds.

It's very good to know that it is possible to get to the heart through all of that scaring! ANything seems possible these days. I have had plural effusions and pleurisy as well after some surgies. It's more annoying then anything.

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At age 20, I will be getting a pacemaker in few weeks along with an SA node ablation. This opportunity may change a five year prognosis into a normal life span! I look forward to being a little old lady with a wicked cane!