New lead--maybe

Hi all, I' hoping someone can give me an idea or two about what I can expect if I have to have a lead replaced. I've had a "thumping in my chest for a long time that the dr. never witnessed, so he didn't answer my questions about it. It got a lot worse and finally the dr. was around when it happened. He said he thinks it's from a lead interfering with my diaphragm's nerve (vagus?), and I may have to have a new lead put in. Is the old lead removed? Is it difficult or painful? If you've had it done, could you please tell me your experiences? I understand it may be different for me, but my appointment isn't for a couple more weeks, and I need some ideas to wrap my head around, rather than worrying.
Thanks for your support!

6 Comments

how old?

by Tracey_E - 2010-06-03 09:06:11

How old is the lead? If it's under a year, they should be able to reposition it rather than replace it. After a year, scar tissue holds it in pretty well so they simply place a new lead on top. I had this done in January. My leads are 16 yrs old so they did a venogram first to make sure the vein was elastic enough and had enough space to fit one more. Normally, you can easily fit 3-4 but after a lot of years stenosis can set it and make it harder to fit a new one. I had plenty of room so they put the new lead in the same vein.

It's the same procedure as getting the leads the first time, only it's easier because you already have a pocket for the pm.

It is possible to remove the old lead. They'd do it with a laser sheath, it's called an extraction. This is done when more leads won't fit or sometimes on young patients so they can have a fresh start with the new lead since it's anticipated they'll live long enough to go through multiple new leads. I'm 43 and we briefly considered extraction but opted to leave well enough alone. Some day I'll likely need an extraction but I'll cross that bridge when I get to it!

Good luck!

harder for me

by macoymom - 2010-06-03 11:06:29

just imo my recovery was much harder having leads replaced... I had stitches the first time and staples the second ... hope it goes better for you though... I think my recovery was also hard due to the serios dizzy spells that took a week to ease up ... keep us posted.

space

by Tracey_E - 2010-06-04 07:06:39

Ask your dr how he plans to figure out if you have enough room for another lead. I saw one surgeon who was really blase about it, said oh yeah, there's a 50% chance it won't fit then I'll just run it to the right side. Uh yeah, ok, lol, can you say not letting him near me with a knife when I'm under!? I went to another dr who wanted the venogram first. Venograms are easy, it's just an xray with an iv. He was going to do it at the time of the surgery but I felt better doing it the week before. I wanted to know the game plan in advance if it wasn't going to fit.

bunnykin has excellent advice. I'd pursue that before a new lead.

More than I thought...

by susan-59 - 2010-06-04 08:06:21

Well, thank you all so much for your experiences and ideas. There seems to be more to ponder about the curing of my thumping than I had realized. I guess I've been so lucky so far, that I haven't really had to think about other possibilities. I like the idea of having the venogram earlier than the surgery much better than waking up to a surprise.
Can I ask you all--do you feel like your cardio is a wee bit paternalistic or patronizing? Just wondering if they all seem that way...
Thanks again

New lead--maybe

by susan-59 - 2010-06-04 11:06:45

Thank you macoymom and TraceyE for you comments. I hadn't even thought about some of the things you mentioned before. My pacer is about 51/2 years old, and I have very narrow veins according to my dr. I see my dr. in another couple of weeks, and your info should help keep me from getting too nervous before then. (And I think my dr. is really good at what he does!) I'll keep you posted. Thanks!

Diaphragmatic stimulation

by bunnykin - 2010-06-04 12:06:52

Hi, just want to share with you my experience; Yours may not be similar but worth your asking your doctor. I had similar pulsation on the left diaphragm 4yrs ago and like you my doc didn't notice till it got worse. My case was unfortunate in that my ventricular lead(my device is ICD) perforated my heart wall and was stimulating the diaphragm. There was no choice in that case but to remove the entire lead and replace a new one. At the same time in any case I am small framed and my veins are definitely insufficient to accommodate another cable. You could ask your Dr why there's stimulation at the diaphragm...lead moved or perforation? Hope all goes well meanwhile, pls monitor yourself and good luck on your followup check. God Bless. bunnykin.

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