25 year old leads breaking down

Old Leads

by Good Dog - 2020-01-20 16:45:33

I have a 33 year old atrial lead and a 27 year old ventricular lead. So my leads are older than yours, but I have not experienced the problem you just wrote about. My 33 year old lead is having problems with sensitivity settings, so I am guessing that my next generator change may involve lead extraction/replacement, but II am not sure. Your episode actually sounded a little bit like an anxiety attack from your description. It seems that with the symptoms you mentioned not likely connected to your PM, but then what do I know? I had an anxiety attack with all the same smptoms except for the pulled muscle.

lead noise/replacement

by heckboy - 2020-01-20 19:12:24

Hi there,

At my PM check last week they found some noise on a lead which indicated a fracture. The lead is 12 years old and from my second PM. I was scheduled for a lead rextraction and replacement. They consider it an emergency because your PM could interpret the noise as your natural heart working and stop. If you're dependent like I am (my resting rate is about 30bpm) you'd likely pass out or worse. 

Today was my second lead extraction and replacement and my 4th PM ( I'm literally typing this from my hospital bed!).  
 

Old Leads

by Good Dog - 2020-01-20 19:44:17

Actually, my escape rhythm (resting rate) is the same as yours. Sometimes it is closser to 35 bpm. As long as I am sitting or laying down, I am just fine when they turn-off my pacemaker. I don't even feel bad at 30 bpm. Now I am sure if I was walking around, I would not feel fine, but my body tolerates that low rate very well. When I was in full heart block and got my first PM, my rate was in the low thirties all day and although I didn't feel good, I was able to function. I worked all day before going to the hospital.  So I guess that everyone is different. That is what my doctor told me. 

Since I'll be undergoing the same lead extraction as you, you'll have to write let me know all the details and how it went. I wish you the very best!

Sincerely,

David

Lead extraction

by heckboy - 2020-01-20 20:42:38

What can I tell you? This is my second extraction and replacement. I'm in ICU right now watching TV. The procedure took about two hours this morning and I expect to go home tomorrow.  
 

they inserted a temporary lead from my right leg to keep me pacing during the proceedure. That was not impactful at all. They inserted a catheter which was done while I was asleep... it's removal was not particularly pleasant. The site is still sore, but they give me a little morphine when I mention it.

best

chris

Old Leads

by Good Dog - 2020-01-21 16:07:13

I am guessing you are home now. That is great and it must be a relief to have it all behind you. Probably the most important thing I am wondering about is; how old is the oldest lead you have had extracted? The reason I ask is, because the older the lead, the more difficult and dangerous it is to remove it. What with my 33 and 27 year old leads, I am concerned. At what Hospital did you have it done? I probably should have PM you. I can if you'd prefer?

THANKS,

Dave

Extracted lead

by heckboy - 2020-01-21 17:37:20

Hey Dave,

Yeah, I was released early this morning.  

My first lead I had extracted was only 4 years old and this most recent one was 12.  The first one I had partially pulled about a year in and we decided to leave it and simply turn up the power to compensate. The second one had a fracture and created noise during my PM check. 
 

My Dr said there was quite a bit a tissue to cut through to free the lead. I don't know if the scarring continues to build after the first few years or what exactly consistutes "a lot." He said it went smoothly, but for him to mention it at all implies that he was surprised to some degree. My operation was done at ST Joe's in Burbank, Ca. 

chris

Least favorite parts of the proceedure

by heckboy - 2020-01-21 17:51:14

Being a relatively hairy guy, the worst part of every proceedure is the removal of the tape afterwards. It's excruciating.  So this time, I shaved myself before going in, which was the best decision I have ever made. I think the woman who's job it was to shave was slightly disappointed.
 

They also inserted a catheter this time and a temporary PM which was inserted up my thigh (my resting rate can fall below 30 bps) The latter was relatively invisible to me and the only evidence is one, small stitch. The catheter was inserted while I was asleep (thank god), but removed last night. That was the least favorite part of the experience to put it mildly.

My PM had almost ten years of life left, so they didn't replace it. Operation took about 2 hours. 

Thanks for your comments

by Narelle - 2020-01-21 18:46:50

Thanks all for your replies, It would of been so simpler if they had been able to take the leads out each time they changed the pacemaker like heckboy (Ive had 10+ since 1975) but they didnt have the technology so they had to either leave them there floating or use the old one again and hope for the best.. Which is my case.  

Ive been givlen four scenarios,

1. they squish in another atrium lead, that makes 5 through the vein, 

2 They remove the 2 year old pacemaker and try and get the leads in via the other side, not sure what happens when it comes to the SVC that will make 6 leads. - probably thrombosis.

3.  They give me an epi cardial pacemaker and Im back to thudding away

4. They try and remove the 25 and 35 year old leads to make room for the new ones.   (mmmmmhhhm thats very scary!)

Anyway Im having a meeting this avo with the surgeon, and surgery tomorrow, so Ill let you know how I go...  Good Dog.  As you seem to have the same concerns too, to alleviate your concern I have 4 leads in - 3 ventrical and 1 atrial, all going through the same vein, so there is room for new ones  ...   You will be fine when that day comes. 

That’s a lot of leads!

by heckboy - 2020-01-21 19:50:03

Wow, five sets of leads! Is your dr suggesting removing them all?  How many times have they done this? Mine has done over 4500.

THANKS Chris & Narelle

by Good Dog - 2020-01-22 16:58:20

Wow Chris, your Doc is a real veteran at doing exractions. That is so important! You are fortunaate to hve him. Narelle; The Cleveland Clinic Docs gave me your option 3 as the most likely for me, because that is what they almost always do in a situation like mine. It isn't a bad option, but I'd prefer not being opened-up. I'm assuming they have to open your chest, but I don't know.

I just want to thank both of you for all the helpful information. I am grateul! The three of us combined have more years with a PM than almost two normal lifespans. That is pretty cool. 

Another alternative that I have considered is Bundle Pacing. There are not  lot of places that do bundle pacing, but the evidence suggests that your long-term outcome is better than convention pacing. There is the need for only one lead instead of two. My Doc and those at the Cleveland Clinic are not concerned so much with my getting another lead placed as they are with having a 3rd lead through the tricuspid valve. They worry that the valve could leak too much or become damaged with three leads through it. In any case, wiith Bundle pacing they place only one lead to pace both the atrium and the ventricule. It has to be precisely placed in the "bundle of HIS" in the atrium. Obviously, I would have the option of getting just one new lead that would not need to be put through the tricuspid valve. So that would preclude having any of the old ones extracted. 

I don't know if either of you are familiar with pacemaker syndrome? It is simply put; that after many years of pacing, your heart is basically desensitized to the extent that the PM isn't as effective and you eventually end-up in heart failure. Well, with Bundle pacing they've found in a study (as they had thought) that the likelihood you'll end-up with pacemaker syndrom and heart failure is dramatically reduced. You heart function over time is much more normal than with conventional pacing. So anyway, that is the story as I understand it. My explanation may not be artful, but I think I made my point????

Dave

Going to do nothing!

by Narelle - 2020-01-22 19:31:21

Hey Good Dog and Heck Boy - the consensus with the pacemaker tech and the surgeon is we do nothing except monitor 3 monthly and hook up the remote monitoring if Im worried about anything.   

I have another 8 years to go and the ventrical lead is just fine, it appears the atrial lead is fractured and exaggerated movement is making it short out, so just need to be careful with my movements and be monitored more closely. 

Oh yes nearly forgot your right Good Dog it was a panic attack cause i recorded the time and there was no event at that time, just a litte run of ectopics about an hour before end.  So remote monitoring could be really reassuring in times like that - although Im 60 now and that was my very first panic attack, at least i know what they feel like. 

I live in Australia so Ive never heard of bundle pacing, Ill investigate but Good Dog i seriously think if ive got 4 leads in there and havent had any drama for the last 3 pacemakers you should be ok to have a few more put in.  But thats just my story.  

Good luck everyone Narelle 

Thanks Narelle!

by Good Dog - 2020-01-23 16:57:06

I like your plan and your story. I am glad to hear it! I guess that I am also in do nothing mode. Even though there are problems with my 33 YO lead, we are just monitoring it for now. 

I just turned 71 and I think I had my first anxiety attack maybe ten years ago. I have only had one since then. They are terrible, because the symtoms can mimic all sorts of bad things like heart attack, breathing problems, etc. I am a natural worry wort which is why I guess I've had a couple.

Anyway, glad to hear all is well. 

Dave