New here, dad is nervous

Hi, hope someone here can give me an answer....my dad had a pm placed last week secondary to low heart rate with exercise. He has a dual chamber pm with the rate set at 60. He went for his first checkup yesterday and they said it was not working correctly and accused him of not behaving post op and are questioning a dislodged lead. He has had one episode of sob-which was his primary complaint, and he also had an episode of lightheartedness .

They made some adjustments and told him it was now working and to come back in one week for another chest X-ray. He is freaking out, unable to sleep, and when he called the dr who inserted it he is out of office for 2 weeks. He is afraid he is a walking time bomb! Upon insertion the dr did tell him he was a little surprised with the size of his heart, could this be part of the problem? Do you think this a good plan or should he insist on seeing someone else sooner? I really appreciate help....

4 Comments

ditto

by Tracey_E - 2012-01-13 02:01:25

What Patch said! Sounds like he ran into someone who needs to be in a lab, not with patients. Occasionally leads can dislodge, more often than not when that happens it's not anything the patient did, the lead simply didn't stay where it was put. I don't understand how they ever get any lead to stay put! The heart is a working, moving muscle. It doesn't hold still for a sec so they can get the lead implanted. So, for a lot of reasons sometimes they dislodge. But if he is pacing and everything is ok on the report, the lead is fine. I'd call and ask to be seen when the dr gets back just so he feels better but it sounds like nothing more than a lousy technician.

Leads......

by Pookie - 2012-01-14 01:01:07

Hi. Sorry to hear that your dad is having so much anxiety. It's easy for us to tell him it's okay and he's not a walking time bomb, but this is all new to him and quite understandable.

I was 42 (in 2004) when I had my initial implant, 2 days later I was in the ER (long story) but basically one of my leads dislodged, so back into surgery I went, then it dislodged again, and then a 3rd time all within 10 days.

Fast forward to this past November when I went in for my usual 6 month interrogation and guess what? - my ventricle lead (the bottom one) is either fractured, dislodged, or scar tissue has built up on the tip so it's sucking my pacemaker dry....meaning it's using up the battery way faster than it should be. An EP (not my EP) was called in and they (he & the PM Tech) adjusted one of my settings and told me to come back in 3 months!!!!!! I was stunned stupid & partly in shock.

So, I went to my family doc, she gave me a req for a Xray and I should have the results next week. Backing up a bit: I called my EP after I found this out about my lead and low & behold - he's on a leave of absense!!!! I asked who was going to be taking care of me and the secretary said something to the effect that with him on a leave of absense the rest of the EPs are trying to juggle all the patients and if I wasn't satisfied with waiting until February to come back then please have my family doctor call. But I'm used to this kind of treatment so I didn't expect better service. Frustrating to say the least.

I too was initially not only peeved off, but also I'm still a bit nervous/stressed because I know I didn't do anything to fracture or dislodge my lead. It's been in there since 2004. Anyways, like I said I should have the Xray results back next week - which I think the PM Clinic should have ordered back on November 24th!!!!!!!!

I just found out this week that I am to go back to the PM Clinic on February 10th. So, in total it will have been almost 3 months of waiting/stressing cuz if it is fractured, then that means another surgery - totally NOT what I need at this time in my life.

Leads do fracture, Leads do dislodge - it just happens.

You didn't mention if his doctor is a Cardiologist or an EP. I had a Vascular Surgeon implant my pacer!!!!

Regardless, for peace of mind, if you can get into see someone to discuss the lead issue AND the comment made about the size of his heart - I wouldn't wait for his doctor to come back in 2 weeks if someone else is willing to see you....but that's just me.

2 weeks of worrying will seem like 2 yrs. Again, all you can do is call and see if another doctor will discuss this with you, the worst answer you could get is no.

So, I'm kind of in the same boat as your father, sit, wait, and worry as if somehow magically the lead can fix itself.

And perhaps in both of our cases - it could be that the PM Tech made an error.

Take care and please keep us posted.

Pookie

episode of sob

by ElectricFrank - 2012-01-14 12:01:34

And I don't mean Shortness of Breath. Must have referred to the doctor.

frank

? Displaced lead

by Samantha - 2012-01-16 06:01:29

Hi,

Sorry to hear of your Dad's problem and your worries!

I agree with the people above, your Dad's care seems to have been unsatisfactory, to say the least.

An x-ray will reveal which lead has become displaced, or failed to attach to the heart muscle in the correct place. From what I understand, this is a fairly common event, and happens more often in people with abnormal heart structure, such as an enlarged heart. The heart can become enlarged when it has suffered a long period of having to work harder to keep you going.

I'm guessing here, but it very much sounds like it is the atrial lead that has become displaced. The technician would have been able to know this with some certainty from interrogating the pacemaker, but should have had this confirmed by x-ray if possible, before doing anything about it (in my opinion).

The atrial lead is just one lead the pacemaker uses, to maintain a regular pacing rhythm across the atria. In complete heart block, the electrical signals fired across the atria, do not reach the ventricles. The ventricular lead serves to 'catch' the signals from the atria, and when it senses that there is none, it fires it's own signal across the heart ventricles, the pumping chambers, in a regular rhythmn.

If the atrial lead is displaced, it doesn't matter too much. It can be turned off, and the ventricular lead can be set to maintain a regular paced rhythmn, which can vary, i.e. go faster or slower, depending on how much activity the body is doing (it is fairly clever that way!).

Little kids get pacemakers with ventricular leads only, because the dual chamber ones are much bigger, and too big to fit in their chests.

The advantage of the dual chamber pacemaker though, is that it is more 'physiological'. The firing from the atrial lead and ventricular lead is co-ordinated and mimics a normal heart conduction pattern much better. I don't know all the ins-and outs of it all, but dual chamber pacemakers are better for you.

If I'm guessing wrong, and in your Dad's case, the ventricular lead is displaced, then I would imagine that the technician would not have been so unconcerned, and would have acted more urgently. In complete heart block, that ventricular signal is the most important 'back-up' signal that is needed to maintain a satisfactory heart rate and rhythmn.

I'm not an expert, but from my own experience, all I can advise is that your Dad needs an x-ray to confirm the problem. If a lead is displaced, it needs to be re-sited or replaced. This should be done as soon as possible, certainly within weeks, not months, to limit the risks associated with the operation to re-site the lead (if the lead becomes attached to a 'wrong' part of the heart, there are risks associated with yanking it back out!)

I had an atrial lead dislodgement about 20 days after my first pacemaker implant. I was found to be pregnant the day of my operation to re-site the lead, so had to continue with the pregnancy with just the ventricular lead working. I was fine, and so was my baby.

About 4 months after the birth, the dislodged lead was removed and replaced with one that 'screws in' to the heart muscle. It's hard to say if I have felt any major difference between having one working pacemaker lead, or two, especially since I have had another baby since then, and as any mother with two toddlers will know, you are permanently tired anyway!

Good luck to your Dad!


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