Missed Beats

odd

by Tracey_E - 2018-08-20 22:51:42

If you have a two lead device and it's working properly, there is no reason whatsover you should be missing beats. If the lead has a problem, that should show up in the report. I'm no doctor, but I don't see why he can't figure it out! It's either pacing or it's not, and if it's not then something is wrong with the lead. Are you pacing ventricle at all? 

It's possible there is a connector at the end of the lead where it screws into the box. I'm just guessing and thinking out loud, but if that came loose maybe an xray would show it? Leads are interchangeable between brands but some of the older ones connect differently. Mine has this big funky connector that glows in the dark on my xrays.

I had a lead go bad when I was on my 3rd device. I had room in the vein (confirmed with an iv with dye in the cath lab) so they simply capped off the old one and added a new one. Easy fix. The other option would be to extract and start over with new everything. I'm older than you so I chose to put that off as long as possible, hoping that my next set of leads will be my last. Also, my leads are very old so removing them is risky. If you are low risk for extraction, they may prefer that. Do your homework and ask a lot of questions. 

Good luck figuring it out!

Ugh

by Leahpia32 - 2018-08-21 13:25:02

I do have a 2 lead device and it seems to be beating in the ventricale normally most of the time.  I was seen Friday and we did all kinds of manipulation to try and get the beats to miss while I was connected to the main device machine with the device nurse and of course, no episodes fo missed beats until 2 hours after I left.  Since I left the hospital on Friday following the tests the missed beats have become much more frequent and feel like the episodes are lasting longer than prior.  

A CT scan I had recently showed the ventricular lead was "deep" in the heart muscle and he was not sure if this was a shift or not since he did nto have another CT to compare to.  It is just so weird to me that with my first PM that i had for 10.5 years I never had any of these issues.  

He made a comment that he thinks that this is a cause of the lead and that it would be a risky procedure to do, but would be needed to hopefully correct the issue.  I just dont understand HOW it just started one day! 

leads

by Tracey_E - 2018-08-21 15:14:28

Leads age, they don't last forever. Average lead life is 15 years but sometimes they barely get through one device, other times they last 20 or even 30 years. Insulation can rupture or break down, scar tissue can build up so they longer pace like they used to. With mine, the insulation ruptured. It still worked but they had to crank  up the juice to get the signal through so it shortened the battery life, then I had it all fixed at once. It probably didnt start one day. It was probably a gradual thing then one day it was bad enough that you felt it.

I still don't understand why they aren't finding it on the pacing report. If they know what day/time you had an episode, they can see if it was pacing ventricle at that time. Also, impedance goes up as leads break down, so there are other numbers and things that show up on the report. 

many

by dwelch - 2018-08-28 02:05:50

I have a 31 year old medtronic lead I am still using I have a 31 year old medtronic lead I am not using. I have 24 year old guidant lead I am still using and a one year old boston scientific lead I am still using.   The medtronic and guidant leads have seen medtronic pacers, a st judes and a boston scientific.  Certainly when you have the condition that Tracey and I have this is the norm.  A lifetime of pacers and parts.  They can pull the leads out as needed, I was fortunate that there was room for a fourth.

If I live long enough I will probably have to move to the other side, new device new leads.  Folks talk about them leaving the old stuff in, will see when the time comes, there is a risk with surgery no matter what, pulling out four leads has gotta be four times as risky as one.  At the same time all those leads going through valves and having them leak has its own risks.  I have only had that converstaion with the doc in the sense that she said those words not necessarily the if you live that long.  But at some point we will need to move to the other side and the longer we can put that off the better.   I am 50 almost 51 years old, had pacers for 31 years, technicaly I could live another 30 years and need 30 years more worth of pacers so she is not wrong.  I may have to move to the other side and get a few devices over there.  And maybe have a breakage or two on that side as well, all the time aging such that the risks go up at some point for these procedures.

So anyway, i wouldnt assume it is a branding issue, if it were I would have expected you to see this at implant time.  But as Tracey pointed out it could be normal wear and tear independent of the brands involved.  You could have simply broken one.  I also do not understand why they cant see this on the recorder.

Its been a week since your post I hope there has been more recorder and/or office/hospital time where they figured this out or have narrowed in on it some more.