Pacemaker with high threshold

My son got his pacemaker replaced last year but need to replaced again this year, the new PM will only last less than a year because the threshold is needed to be on set as high as 6, 2 months after the operation, the doctor said that reason can be a wrong location of lead in the heart when the replacement was made last year. This is very disappointing situation and thinking to sue the doctors. Doctors even said that replacing the lead and batteries will not make sure that a low threshold can be achieved so to give long battery life. Currently my son is using epicardial system where his generator is placed on his abdomen, doctors are proposing to changed the system and use the transvenous but in doubt because he is too young to use the transvenous approach.

Has anybody undergone a similar situation. Please do share you experiences.

3 Comments

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by Tracey_E - 2009-06-22 07:06:21

How old is your son? We have a few parents of kids with pm's here and some kids who are teens now but got their pm's as babies. There is a yahoo list for parents of children with pm's, that might be a good place to ask your question also. I can't remember the name of the list but if you search the old posts here it should come up.

I also currently have a very high threshold and, therefore, short battery life because one of my leads has gone bad. It just happens sometimes, it's not usually anyone's fault. Sometimes the leads just don't stay in place, sometimes they go bad. I chose to keep it last time I had a battery replacement but I'm getting a new lead next time.

Have they said why they can't replace the lead and get a better placement? I'm not an expert but I think that at one year they can still remove the bad lead and replace it pretty easily. In my case, I've got 15 yrs of scar tissue holding it in there, so another lead will be put on top of the bad one. Are you working with a cardiologist or EP? If you haven't had him seen by an EP yet, that might be your next step. Cardiologists are mostly plumbers, EP's are the electricians and might be able to tell you more about getting a better placement, or at least an explanation why it can't be done.

Best of luck to you.

High Threshold

by raadaya - 2009-06-22 10:06:32

My son is going to 7 this July, he has congenital heart block and had his first pacemaker on his 5 days old.

We already got the opinion from EP - Electrophysiologist and gave advise to change the system to transvenous this coming october or november. But still need to know which is the best way to have it resolve, to use the transvenous or just changed the lead? They said if just replacing the lead and still use the epicardial system doctors may not find better place on my son's heart to attached the lead. Actually this is the 3rd lead, the first one was broken when he is 1 year old when he fall down from bed and second one was replaced last year.

Is the scar tissue reason of high threshold? And having 3 leads already placed on his heart made a scar on the heart? How many leads doctors can attached to the heart using epicardial system?

Can we ask the meditron to changed free of charged and be covered by warranty? I asked this but first they ofcourse they disagree but considering we only use it for 1 year and considering these meditron staff are present during the last operation they must be also responsible on why they have not advise us the consequence and they must ensure that lead are in place properly.

Appreciate if anyone can give advise. My son is very healthy and thanks God for giving life to my very loving child.

kids

by Tracey_E - 2009-06-23 06:06:28

I'm not sure about moving it but I would think that unless he's really tiny, then 7 should be old enough to go transvenous. Maybe one of the teens here will see this and can say when when theirs was changed.

Scar tissue is always what will hold the leads in place over time. My understanding is it's harmless. I don't know about a limit on epicardial leads. Four is usually the limit for transvenous because that's all that fits in the vein.

Scar tissue shouldn't have any effect on threshold. They have to turn it up when the signal isn't getting through. The only two reasons I know of are the lead is not placed well and the lead is impeded. Think of the window open with the air conditioner running. It still cools the room but the power bill is a lot higher.

The manufacturer's rep is always present during placement so they can program the new device immediately when it's turned on. Unless you got a recalled lead, I don't think you have any recourse against Medtronic. The surgeon is the one who does the placement. If the lead won't stay put, I doubt if anyone is to blame. That has more to do with the heart muscle and the patient's size than the skill of the surgeon. An ep is considered the highest skilled and has the best chance of getting it to work.

CCHB is what I have also. I'm 42, a mom, a business owner, active and healthy! Pacemakers rock :o)

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