New Leads, it is

First, thank you to Don R & Frank as they lead me through the pacer maze to come to the right conclusion - have my R turned off and my upper and lower limits reset.

I went into the cardios office today and got the records from my old pacer. I then went to see a tech and asked for my numbers to be set the same, including turning the R off, which is how my older pacer was.

Then I also explained since I had once again passed out, I felt my remaining lead might be compromised and I wanted him to be sure to check it.

He reset my pacer, including turning the R off. I was already feeling so much better! Thank God! I still was a bit worried about my lead, so I asked him if he was able to check the lead. He said yes, and that he would be right back. He came back and I told him I felt so much better, but I knew that I had another issue with the pacer. He told me I had multiple issues and then he proceeded to make another change. I asked him what he did and the answer was that he was turning the ventricle off and that the dr. was going to talk with me.

Dr. says surgery Wed to insert new leads. Can't figure out what happened to the leads/pacer. He's be inserting pacers for 30 years and I'm the first patient to be paced about 10% of the time and yet pass out. Old leads will stay in.

Nervous now as I really don't have time to get a second opinion. Really don't care for the position I'm in.

I did tell the dr before he began talking that I was going to talk first. I told him I felt the tech could have nipped this in the bud had he been paying attention the first time I came back to the office to have my pacer interrogated. The dr agreed and said he had already been on the phone with him.

Word to the wise here - if you are having issues and your pacer is fine - be sure they check the leads.

Now to Frank and Don R - if they turned off the atrial, does that mean the ventrical will pace at X beats a minute? In my case the bottom number is 60. Am I at a great risk to pass and is it impertive to have the surgery ASAP? Would you ask for a new unit also?

I was in a hurry as I have vacation plans for next week. I think someone just rained on my parade.

Thanks!

7 Comments

I pass to Frank...

by donr - 2012-06-05 02:06:01

Mary: Congrats on working this mess to a conclusion - maybe. All I did was repeat advice that Frank had given on the RR. I just happened to be on line when he wasn't & figured that in your current state, you needed info immediately. Sounds like Frank struck paydirt again - through a surrogate, but it's his credit.

You obviously have your cardio's attention if he wants to do the lead replacement day after tomorrow!

A question you need to ask him before anything untoward happens - "Does he plan to remove the current leads?" The Sub clavian vein is pretty big, but I face this issue once & the EP said that he may or may not be able to place a THIRD lead in me due to space considerations. This leads me to suggest that if he is going to put in TWO NEW leads, he is either 1) removing the old w/ a laser roto rooter to make space, or 2) going to switch to the other side & go down through the RIGHT Sub Clavian vein.

If he palns to do the roto rooter job, ask about his experience at it, how many he does a year, etc. You need to vet his capabilities & qualifications quickly.

Roto Rooting a vein to remove leads is definitely a non-trivial procedure w/ significantly more risk than a simple PM implant. You want to choose carefully the EP you have do it.

I'll leave the rest of your questions to Frank. He's on line right now.

Don

No lead removal

by Mary1998 - 2012-06-05 09:06:37

@ Don - he doesn't want to attempt lead removal. I will address that issue later, I guess. By later, I mean the next time I have to have a lead done. Althought there's part of me that thinks it would be easier the younger I am. I would NOT have him do the removal, although he has done it.

I'm stressed over this as I really was ready to seek another dr. and do have an appt on Thu for that - guess I'll have to cancel that and address that later. I have a lot of thinking to do on it. And, I can't get into the hospital of my choice now.

The one thing I'm not certain of is my state of healther with the atrial turned off. I'm thinking with that and with my passing out from time-to-time it' behooves me to move along with this.

Thanks for the support. I'm off to have my pre-ops done.

Before you do this surgery...

by donr - 2012-06-05 10:06:04

...we need to exchange a msg on lead removal - ther is some good stuff on the web about the considerations involved. Have a good day.

Don

Lead

by SUPERSALE - 2012-06-07 11:06:33

which pasemaker is you

doctor should show you a Demo pacemaker which one is you how big what it look like it might have alots of picture of pasemaker on the wall to show people what it look like

Don - too late

by Mary1998 - 2012-06-08 06:06:39

You haen't heard from me as I went into ER again on Tuesday and just came out with my left side sans pacer and my right side new leads and the paper implanted there.

The story is the pacer and leads checked out fine on the testing equipment - but the leads didn't carry any mssgs to the heart. They can't seem to figure it out.

I'm sore and tired, and am hoping we now have a working solution for now. I will probably go talk to another EP in a few months re: lead removal, the best ways to approach any new lead replacements I might need.

I truly appreciate your informative posts.

@supersale

by Mary1998 - 2012-06-09 01:06:43

Not sure about your comment; perhaps you meant it for another post? I've been a pacer patient for 14 years, so am not worried about the device, itself, only worried about the condition of my leads. I know have new leads on the right side and the pacer is implanted on that side.

A guess as to what's wrong

by donr - 2012-06-09 10:06:38

Mary: I'll get a line from Sherlock Holmes: "When you rule out everything that is impossible, what ever is left over, no matter how improbable must be the truth."

Sounds like the only thing left over in your case is the places where the leads were implanted! Those spots must have developed a high enough resistance to prevent the signal from the PM to get to where it had to go to stimulate the heart to contract.

Something for you to ponder - do you REALLY want to have the unused leads removed? If they are causing you no problems, you have to balance the risk involved in an invasive procedure against the gain - which, if you are having no problems is not a good trade off.

To bring up Frank's comment every time I mention that lead removal has a risk of about 1% in the hands of a very skilled & competent surgeon. He says that it means that 1 out of every hundred doesn't survive the operation. That doesn't sound too good to him. To me, either - when you talk about it being a truly elective procedure. The horse changes color when the procedure is absolutely necessary for continued life.

Face it, however - at your young age, some day you will probably need the space for new leads. You DO realize that all FOUR leads occupy the same vein going into the top of the heart - where the two (Left & Right) sub-clavian veins join, & become the Vena Cava for their final plunge into the abyss known as the right atrium. Naturally, the Vena Cave is larger in diameter, by at least a half to accommodate all the blood in it. Some day you may have to have some leads removed to make space for new ones. Just stick this thought in the back of your mind for the future.

Hey! look at it this way - if you feel good at this point - for a 300 game in bowling, you need a strike in EVERY frame. sounds like you are on a roll!

Don

You know you're wired when...

Jerry & The Pacemakers is your favorite band.

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