Possible Fractured Lead

I have had my st. jude's pacemaker for around seven years now, I moved and have changed cardiologists. Within the last three months I have had an increase of impedence which is causing my dr to think that I may have a fractured lead. My question is: if you have had a fractured lead, can you have shoulder pain to go with it? and can it cause a small pinching feeling in the pacemaer area? I am coming up on the end of the battery life, so I know surgery will be within the next year, but am trying to make sense of this possible fractured lead before that time comes. I go back for another PM check in december, but that seems like it is so far off. Should I try to get one sooner to see if there is problems? Any advice?

8 Comments

new symptoms

by Tracey_E - 2013-09-20 01:09:38

Any new symptoms should be evaluated, though that sounds pretty minor to me and could be attributed to other things. Maybe just call and ask if they want to see you?

I did not have any symptoms when my lead was fractured but depending where/how it is fractured you might feel something.

If the impedance is going up on the lead, it will shorten what's left of the battery life so don't assume a year. Three months until the next check seems reasonable to me if they think it has a year left. Is this your first replacement? When mine get under 6 months I go in every 2 months, then every month.

fractured leads can...

by donr - 2013-09-20 01:09:53

...act in many ways.

I lost a lead after 4 yrs. It completely separated, but before it did that, I felt a continual electrical discharge type shock in the pocket where the PM was. What I was feeling was the current return to the PM via my body. When it finally separated, I felt nothing - the lead was open.

Do not be surprised if your Cardio has a hard time pinning down the cause if it is a fracturing lead. It took 1 Cardio, 1 EP, 1 PM Tech Rep, three nurses & one pushy electrical engineer PM host to finally figure out what was happening. It was the EP who finally had the "Eureka!" moment that nailed the cause of my problems.

Don

Im doubtful that it's the lead causing that

by PacerRep - 2013-09-20 02:09:00

A fracture is usually all contained on the inside of the lead. If your due up for a battery change they will will take care of both problems at the same time. Are you pacer dependent? do you use the lead that is fractured? This all attributes to the severity of the issue. If you don't use the lead that's fractured it's no big deal for right now. Many times they will fix the lead right away and also change the battery...even if it is not quit ready yet.

Good advice as usual from Tracey and Donr...the only thing is Tracey...when your impedance goes up, the resistance increases which actually increases the battery life, not decrease. If you have an insulation break and a low impedance then you drain the battery.

Think of a garden hose for this analogy. A fracture is like a kink in the hose...not much water/battery being used. An insulation break is a hole in the hose...water/battery spilling out all over the yard.

fracture vs insulation break

by Tracey_E - 2013-09-20 04:09:09

I did not know there was a difference between fractured and insulation break. I learned something new today, thanks! I was told fractured and given the leaky garden hose analogy when my brand new battery went kaput in 2 years. I guess mine was an insulation break because it's the lead I am dependent on but we weren't in any rush to fix it, just cranked it up and watched until the battery was dead.

Yes that can happen as well

by PacerRep - 2013-09-20 09:09:08

Usually they fix it before the problem degenerates this badly but yes that can certainly happen...I've seen it a handful of times. The energy has nowhere to go and if it can't bleed out it makes a u-turn.

You got it

by PacerRep - 2013-09-20 09:09:10

Yes you had an insulation failure. Basically if you look at any cord in your house...there is metal wires on the inside of that cord, when a fracture happens, those metal cords on the inside break in half.

On an insulation failure, the rubber coating (the part you touch with your hand) wears thinner and thinner and eventually exposes the inner wires. Battery current drains out of the lead and you have to crank the voltage way up to get the heart to squeeze (turn the garden hose on full blast to get the same pressure at the end).

A lead can still work with an insulation failure as you know...usually when a lead fractures it is rendered useless, and it will confuse the hell out of the pacemaker.....hence a little more significant problem.

Actually, you can suffer both!

by donr - 2013-09-20 09:09:14

I had a failure of the insulation & the outer conductor, plus degradation of the coax insulation so my current draw increased for a while. Then the coax insulation & center lead fractured - meaning a sudden break due to brittleness & the impedance went to infinity. There was a separation in the lead of a couple inches. At one point, I had the shock feelings in my pocket because the central conductor was intact, the conductor was not, so my body was the return path. During the entire time I'm not sure I was getting much pacing from the lead. I still have the broken end of the lead in my collection of medical miscellany.

Don

Pacer Rep:

by donr - 2013-09-20 11:09:05

The rest of the story - this all happened in a period of about a month. The EP asked if I'd mind waiting till I had a change out. That was projected for at least 4-5 yrs in the future, so we did it at the 4th yr. Btry went south at the 7th yr.

Don

You know you're wired when...

You fondly named your implanted buddy.

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