Lead replacement

Hi, I'm new here and was hoping for find a little information. I had my pacemaker implanted when I was 18 ( 15 years ago) for complete heart block with no AV junction function leaving me dependent on the device. I have had the generator replaced 3 times but now I have been told that it's time to consider placing new leads as I'm told they usually last about 15 years before they start to malfunction, and cannot take the risk that they might break. My question is has anyone had experience with changing leads? The doctors are debating leaving the old ones in versus trying to remove them. At my age I will most likely need another set at some point and they are concerned with leaving too many in. I understand the longer they are in the harder they are to remove. Anyone recommend a hospital that specializes in lead extraction? Any opinions or thoughts would be appreciated. Thanks.

8 Comments

replacement

by Tracey_E - 2012-07-30 07:07:38

First of all, I would not replace them simply because of age! We have members here who have 30 yr old leads that work just fine. If it ain't broke, don't fix it, but that's just my opinion. They can tell when they check them if the impedence is going up, the first sign they are starting to malfunction. They don't usually stop working overnight, they gradually stop working efficiently and kill the battery faster.

I got a new ventricular lead with my last replacement (#4) because the old one had gone bad, but I still have my original atrial (1993) and it's going strong. I knew the ventricular lead was going bad 5 years before I had it replaced. I kept it through one battery replacement and waited until the next battery died to get it done, by that time it was so bad the battery only lasted 2 years so it was no longer optional. I had a venogram to see how much room there was, there was space for another lead so I chose to add the new lead rather than extract the old. I also have CCHD, a very low underlying rate and am completely dependent. I'm 45 now.

There are two schools of thought on addition vs extraction. Some drs just like to start clean each time and extract automatically. Some prefer to hold off extraction until it's necessary because it has additional risks. As long as we've had our leads, they are complicated to extract whether it's now or in another 20 years so keeping them longer doesn't make it more complicated. Technology gets better every year and it is much less risky than it used to be, but there are still risks.

When looking for a surgeon, find one that does more than 100 extractions per year.

My personal opinion is put it off as long as possible because extraction technology will be that much better in 20 years. Also, if I extracted this time I could be facing another extraction in 20 years, by waiting hopefully by the time I do have to extract the new leads will last the rest of my life. Leads are always getting thinner and more durable. So my motto is procrastinate, procrastinate, procrastinate!

You have a judgement call to make!

by donr - 2012-07-30 08:07:27

It is NOT the cardio community's decision - it is YOURS! You are the one lying on the table zonked outa your skull while some supremely confident surgeon grubs around in your vein w/ a laser roto-rooter. I like that sentence about the surgeons debating lead removal. Where is the principal party to this affair - YOU? Do You sit in on the debate?

I see you are a Texan - so you are not living in a third-world backwater of medical capability. You should be able to find a surgeon coming up to Tracey's criteria for competence.

You missed along discussion on this by a few days. If you'd like to read it, go to the left column & click on "Member List." In the search box for name, type in "pippapewter." Then scroll down till you see her name & click on it. then scroll till you see a list of her TWO posts. Click on the one named "Hi All-" Voila - up pops the post & all its comments.

OK, so much for computer skill exercises. Now for the meat!

Consider the following in your decision:

1) your original heart had a finite lifespan - they all do - yours demonstrated that its lifespan w/o failure was 18 yrs.

2) "They" implanted a PM/leads that, short run, was more reliable than your heart. short run is defined as about 10 yrs. The leads lasted some 15 yrs - not too shabby at all. After all, they were surviving in the most hostile environment known to man (Short of a vat of concentrated sulfuric acid), so they were really on borrowed time. Granted there are some folks here whose leads have lasted nearly 30 yrs - Tracey is witness to that, as a re a host of others. But there are others of us whose leads have failed in less than 4 yrs (Like me) & failed catastrophically, breaking & the two ends going "Sproinnnnng" & separating by a considerable distance.

3) You have several choices:
a) have your leads extracted & replaced - which is at least NOT scaring you crapless.

b) Sit, paralyzed w/ fear & do nothing, which will lead to eventual total lead failure & consequences too horrible to write about in a mixed population publication.

So, you've done research & reading & found a mixed bag of articles that have still leave you w/ questions.

Lead extraction has advanced tremendously in the last ten yrs - using a laser "Roto-Rooter" has enjoyed significant success at low risk. Its success rate is now at about 99% in the gloved hands of a well experienced coronary plumber.

I will send you, in a plain electronic brown wrapper (via the Private Message system in a few minutes), the definitive web reference on lead extraction - in case you haven't read IT yet. I will ALSO send you my litlle monograph on "How to vet an EP for lead extraction."

Even better, if you chose, I'll give you a reference to an EP in Atlanta who meets all the criteria for "Experienced as described in my monograph. For another woman w/ the same issues, I rec'd his permission to use his name He & I already talked lead extraction when I faced its potential two yrs ago.

Hope this all helps - Oh, BTW: there are a bunch of folks in here who have been through this - they will wake up & chime in, trust me If they don't I'll rat them out for you.

Don

Hi

by Gellia3 - 2012-07-30 09:07:55

I'm with Tracey and Don. I have had my leads for 32+ years now (a PM for 37) and as my EP said, "If it ain't broke, why fix it?".

I'm hoping to keep mine forever and no one has mentioned replacing them yet.

Good luck with whatever you decide, but maybe it would be a good idea to get a second opinion on that one.

My very best to you,
Gellia

TraceyE

by polrbear - 2012-07-31 01:07:04

There isn't research on heavy metals yet. It's still theoretical. The recent hip prostestic recall once again brought it to light as a possibility. I am curious about it.

Another concern with leaving leads in is that the increased risk for deep vein thrombosis (blood clot), as each one disturbs the blood flow a little bit. They all add up, even if the risk starts out low.

Another concern

by polrbear - 2012-07-31 01:07:46

I agree with the general age of about 15 years as the normal lifespan of a lead. Longer is certainly possible, but not an everyday event.

The laser lead extraction has some great numbers thus far. My lead extraction was manual (with a laser setup present in the room, but it was able to stay in its packaging), but the lead had been in place less than eight months.

The other concern with leads over 15 years is the gradual release of heavy metals (platinum, palladium, etc.). For most people, they aren't alive long enough to worry. Heck, the coating technology to decrease this release is getting better with every generation of leads. However, it is one more thing to consider before making a full decision. However, it's thankfully more in the theory stage than having numerous well-documented cases.

Dustin

Dustin

by Tracey_E - 2012-07-31 08:07:09

The first year leads can usually be pulled out carefully, no need to extract.

There is no research on very long term pacing, we are the first generation and the guinea pigs, so to speak.

Where did you find the research on heavy metal? I keep an eye on the studies but haven't seen any about that.

lead replacement

by kinerby - 2012-07-31 09:07:33

Thank you everyone for the responses. I apologize for not reading the earlier posts on this subject. But your responses are exactly what I was looking for. I wanted to hear different points of views and opinions on this.

I understand that this is going to have to be my decision and am just trying to make sure I look at it from all aspects. My doctor is not pushing for this, he just simply brought it up at my last appt that it is something we need to think about. He stated that after 15 years is when they are most likely to start failing. I'm do for another pacer change here with the next year and was just trying to find info about it now that it was brought to my attention.

I guess my biggest concern is that I am 100 percent dependent with no underlying heart rate and I don't want to wait until they fail to do something about it, yet I am in no rush to do a lead extraction if it's not necessary. I understand it can be a riskier procedure than any others I've already had ( 8 ablations, and 1 replacement due to recall). I was not aware that you can see when the lead is begining to fail, actually before it happens. That is a relief.

I am in no hurry to replace them, but am just trying to better educate myself for when the time comes to make a decision on whether to just add new ones or to try to remove the old ones too.

I agree that the longer we wait the better technology will get, I just don't want to push my luck (since I obviously haven't had the best history with it). :)

Thanks again,
Kim

lead change

by papaknight - 2012-09-17 06:09:38

The cleveland clinic claims a 98.5 % success rate in lead extraction and replacement. Good Luck

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