Should it stay or should it go?

A little history:
Inappropriate sinus tach due to lymph node pushing heart to side lead to 2nd ° heart block. Heart block lead to PM, allowing for two ablations to my sinus node. Pace 90% in atrium and only 0.8% in ventricular. Have had bad lead in lower chamber for last 4-5 years, impedance getting worse. Looking at new leads and generator in next 6 months. My EP is leaving it up to me to decide which of three options I want.
(1) leave bad lead and not insert new as rarely use it.
(2) leave bad lead and thread a new one in.
(3) remove bad lead and replace it.

I currently have 6 mths to 2.5 years on my generator.

I'm leaning towards leaving the bad lead in place and not adding a third lead. I'm just worried about there being room for another lead. I have to use pediatric lines for blood work or IV's. I have read that sometimes they could go through the other side. Do they use the superior vina cava for that or an artery? I have scaring from a port-a-Cath.

I have until April to figure out all my questions and think about what I want to do. We've decided to replace generator at end of May.

Thank you..


3 Comments

leads

by Tracey_E - 2016-01-13 01:01:27

Is the lead draining the battery as it is? If yes then I'd probably turn it off first choice, add a new one second choice. If it's not affecting battery life, leave it alone.

I had a bad lead for more than 5 years that we didn't mess with. Then it got worse and was killing the battery quickly so we did a venogram (iv with dye in the cath lab) to see how much room was in the vein. I had plenty of room so we added the new one, capped off the old one. I only wanted to extract as a last resort because i'm young enough I expect to outlive these leads, so if I can wait long enough maybe I'll only have to extract once instead of twice. Some drs push for extraction, they like to start with a clean slate. My dr left it up to me, said there were merits to both ways and he was ok either way.

Yes, they can go in from the other side. They also have more than one vein option on the left side but I think they all end up in the superior vena cava. If you ask for a venogram, that will show them exactly what they have to work with. For some reason that's not very common but I don't know why! It took less than ten minutes to do it. I wanted a clear understanding before surgery what we were dealing with so I could make my own decisions, not them making decisions when I was under anesthesia. I met with one surgeon who said "oh, if it doesn't fit on the left I'll just run it on the right". I wasn't comfortable with that so I found another surgeon.

Thing to consider

by Good Dog - 2016-01-14 01:01:49

The thing to consider with adding leads is not so much how much room there is in the vein or which side. It is more about the impact to the tricuspid valve in the ventricle. Generally, two are acceptable. More than that can cause a problem. Despite what some people think, lead extraction is a risky procedure (relatively speaking). Although it is much safer today than in the past. It is my opinion that extraction should be a last resort. Actually not just my opinion. That is the opinion I received at the Cleveland Clinic.
Sincerely,

David

lead

by neff - 2016-01-16 02:01:43

My Dr. agrees with Dave . He has left in a bad iead through 2 batteries changes.
Diane

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