Lead extraction or not

Hallo everyone....quick info then I want your oppinion.
I have Sick Sinus Syndrome and 1st degree heart block. I have a single lead right now but getting a second lead to help me out. Especially with excersize. I have had it for the past 15 years...first replacement was last year. My current lead has a 2 - 3 cm area where is pretty block, scar tissue I believe. So they did a venogram and found that not all the blood goes back into my heart and that some get pushed up into my neck. My doctor said that thats not a big concern that the body adampts to this and makes new paths for the blood to flow back to the heart (hmmm ok). I am not fully reliable on my PM but the last few years I have been using it more and more.

Now they gave me 2 options:
1) do the high risk operation to have it removed. Off course there is a posibility for some major complication. They said that if they remove the lead they believe that the vein would collapse and so they have decided to put a stint in. Then off course they would put the 2 leads in.

2) They leave it in and move my pacemaker to the right hand side (currently its on the left). They said that the leads would be close to the surface and that most people dont have a problem with it. But some do. This is a less risky procedure. The dr said there is a posibility that that lead would also close up but he cant say if it will happen

Now here it is..... my family has a history of heart problems and high cholosterol. I personally would do the removal now, when Im younger and not worry about when Im older. Also what if it completely closes. the doc said the buildup has happened over many years....but I still have many years to go....did the buildup just stop or is it ongoing??? Now what if I choose the low risk of having all moved to the right. What if that one starts closing too.....according to the dr, we will worry about it then. So what if I need a third one? the dr said then we will have to remove one. But they cant say that I will need 3rd one in the future. Granted in 20 years there could have been amazing medical break throughs.... buth what about the next few years. What if I get a small blood clot? if the stint is in it would have an easier way throught the vein then it would now that it is blocked.

I thought I would ask you guys opinion. Puttin risk aside which there is always a risk. What do you guys think of the 2 options?

6 Comments

Age

by jvdinden - 2013-10-25 11:10:01

Hi, sorry I am 30 years old. I got my pacemaker when I was 15, back in 1997. First replacement was last year. During the operation they tried to put a second lead in but because of the blockage they couldm't. I had comlication during it and got a pneumothorax and I ended up staying in the hospital for 4 days.

How old are you?

by PacerRep - 2013-10-25 11:10:14

Let's start there.

Option 2

by golden_snitch - 2013-10-26 07:10:04

Hi!

Now, that does not sound like vena cava superior syndrome as I suggested in your last post, because if you had this syndrome, moving the leads to the right hand side would not be an option. No matter, if you put the leads in on the left or right side, they will always run through the VCS. So, if this vein is indeed occluded, right side implant won't work. It sounds rather like your left subclavian vein, maybe also the left innominate vein is blocked.

Do NOT put a stent in a vein and then put two pacemaker leads through it! That will most definitely cause occlusion again. Stents often become occluded even without leads running through them. So, imagine that with two pacemaker leads going through that stent the risk is much higher. So, in the end that whole risky surgery of removing the old lead, placing a stent and putting two new leads in will lead to the same scenario that you have now: a completely blocked vein.

If I were you, I'd probably go for option 2. Sounds like the less risky.

By the way, I have severe stenosis of my left subclavian and innominate vein, and my doctors, including the cardiac surgeon, said that they will not remove my old, no longer working pacemaker lead that is placed in those veins. They said it's too risky. Surgeon said the tissue is most likely severely inflammed and won't stand neither removal, nor stenting.Due to my history of VCS syndrome and open heart surgery, I now have epicardial pacemaker leads and I'm on blood thinning medication to keep the reconstructed VCS open and to prevent further stenosis of the other veins.

Inga

Ok

by PacerRep - 2013-10-26 11:10:47

Man this is a tough call and I hope you put some thought into it.Lead extractions terrify me every time I do one....and it's for good reason. If you were much older I would absolutely without a doubt say that you just move it to the other side...

But your 30...

The wires they put in on the right side are going to break before you do....In rare cases they last more than 20 years...but thats not the norm, so at your age your going to be getting a few more sets of wires.....

15 years is a long time, that's lots of calcium and scar tissue. Make sure if you choose to extract these that you find the best guy.....I personally would buy a ticket to Miami and get it done there...there's a few guys down there....that's all they do, several hundred a year. I believe Cleveland clinic has some good docs up there too. I can find out if your willing to travel.

Point is, if you don't have them extracted, then in 15 years your going to be in the same boat but now you have 30 year old leads on the left and 15 on the right....You could get epicardials at that point if you wanted to, but a thoracotomy is no fun either.....

Do you have a dual chamber or a single chamber? You may want to think about the leafless pacemaker that's in clinical trial right now if you don't want an extraction...it's single chamber only though...at your age I'm guessing you have a dual.

Keep us updated, and best of luck.

PacerRep...

by golden_snitch - 2013-10-27 03:10:50

You did not mention the stent. I mean, if it was only about removing that old atrial lead, I'd probably agree with you, but NOT when this includes stenting. My cardio, EP and cardiac surgeon (No 1 German heart clinic) have all refused to implant pacemaker leads through a stent. And they have also refused to do stenting in an occluded vein because they said the tissue would break.

What one could probably try is to treat the occluded vein with heparin administred through a catheter directly to the area where the occlusion is. And/or prescribe Warfarin etc. for a while and then see, if the blocked vein got any better so that you can remove the lead without placing a stent.

Inga


True

by PacerRep - 2013-10-28 10:10:21

Obviously every situation is different when it comes to stenting and there are different views on it from doc to doc. There really is no way to offer advise in this forum on that in terms of decision making, but your experience and what you've been told should certainly be shared.

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