What does this mean?

I got a copy of my Dad's medical records and the person who adjusts the pacemaker wrote to the doctor "please note noise
on RV lead and continually increasing capture threshold in RV lead. This is an on-going issue with the RV lead and the patient rarely paces in the vent." I am new to the Pacemaker Club. What on earth does this mean? My Dad is 92 and has aggressive melanoma. Doctors can operate and remove the cancer but do not wish to do so until pacemaker is fixed. Does he need a new lead? Do they replace the battery at the same time? Do they do this under general anesthetic? Can they do this under a local? Any clues as to what this language means and how we can minimize the risks given his age would be most appreciated. Thanks so much.

4 Comments

Static on the radio...

by donr - 2013-11-08 01:11:43

Pacete: Electrical noise is exactly like static on an AM radio, no more, no less. It is an unwanted signal thaat interferes w/ the signal that is wanted.

RV means "Right Ventricular." So your Dad has a dual chamber PM, & the lead in question runs from the PM to the Right Lower chamber of his heart. The capture threshold is the voltage required from the PM to make the Ventricle contract. In order to function reliably, when the PM does send a signal, that voltage is continually increasing. "...and the patient rarely paces in the vent..." means one of two things - it is written ambiguously - that either your Dad does NOT ned to be paced often in the vent(tricles) or he needs it & he's not getting the pacing because of the noise. You will have to ask the Cardio what the exact meaning is.

At this point in your Dad's life - age 92 - IF he needs a lead replaced, it's a risky procedure. BUT - BUT - you have not told us how long he's had the PM or the leads. It could be as simple as capping off the bad lead & installing a new one if he has space in his veins for that, or it could require going in w/ a laser powered cardiac Roto-Rooter to cut the old lead out. The first option is no more risky than an implant procedure. The Roto-Rooter is riskier.

You also have to know EXACTLY what is causing the noise - is it the lead or is it coming from the PM? Either MAY be possible & no one will know that for sure till the pocket is opened & the lead checked independently of the PM.

If they replace the PM, it has an integral battery that is hermetically sealed into the PM Case. The battery goes, too. You did not say how long your Dad has had the PM & the expected life of the battery.

Anesthetic - local w/ sedation IF the simplest case is what he faces - Lead does NOT have to be removed. General IF he needs the Roto-Rooter to cut out the old lead.

Don

What does this mean?

by Pacette - 2013-11-08 03:11:59

Wow! Don, you have helped a lot. I appreciate your answer
very much. The pacemaker was inserted in 2010 and has a 2088TC/52 RV lead. Thank you! I understand the situation much better now.

How does he feel?

by BillMFl - 2013-11-08 08:11:39

If he isn't symptomatic , and given his age (is he healthy and mobile?) there may not be too much they should do, especially if he never paces in his ventricle. I am a two time melanoma survivor. Had my share of surgeries the last major one in 08. If he has metastatic melanoma and requires major surgery he is at much higher risk because of his age. Be prepared for some very frank discussions with his doctors as to the risk vs life expectancy based on his age and overall health. If he has stage IV melanoma, that is the biggest immediate threat.

Feeling good except for melanoma and pacemaker

by Pacette - 2013-11-12 02:11:12

Hi Bill:
Congratulations on being a two time melanoma survivor but I am so sorry about all the surgeries. You certainly know what my father is facing and I very much appreciate your opinion. He feels good with minor digestive problems and is mobile. His mind is sharp as a tack. His melanoma is Stage II with a l.7 mm lesion on his head and Stage 0 on his foot.(in situ based on path report). I understand 2.0mm sends him into Stage III for the head lesion. It is probably the last time to catch it before a spread to the nodes. I agree, it is definitely a tough call. Heart doctor has sent him to PCP to see if he really wants the surgery without seeing him.
PCP was the one that misdiagnosed the surgery for 5 years. I am thinking of taking him to the university that will be doing the cancer surgery to have them do the heart surgery too. I wish you the very best and my prayers are with you. Thanks so much for your input.

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