Pacemaker syndrome/lead out of place 2nd time

Friday 13th

by Domkin - 2020-03-09 00:23:01

I am also having surgery on Friday the 13th. I'm also scared. The vein my 2 leads are in is collapsed.  I also have multiple allergies to my pacemaker and leads. I wish you good luck and will be thinking of you.

Thinking

by ChristopherTodd - 2020-03-09 00:53:33

I will be thinking and praying for you too. Thanks so much for your post.

You ask good questions

by crustyg - 2020-03-09 07:21:27

Will this fix the problem, will I come out of it ok?  All good, important questions.

Reading your history and reading between the lines I suspect that several of your issues were their fault.  But that doesn't necessarily mean that there has been negligence, you may just be very difficult to get the leads in place, get the sheathes into the big vein etc.

If they are insisting on a general anasthetic it will give them more time and less pressure while you are away with the fairies.  My PM didn't go according to time schedule - EP doc struggled to get the sheathes into the vein (dehydrated, ended up head down for 10min to fill up the veins) and my 45min procedure took 90min.  I was fully awake, no sedation, only local (which had worn off by 45min), and it was *much* more difficult than it should have been having me listening to the soft cursing as he struggled with the lines.

Make sure that you have a really good, honest conversation with your EP team, take a friend/relative with you.  Explain that you want to understand what happened last time and what steps they will take to avoid it happening again and that you brought a friend, not an attorney!  *Your* aim is success, not blame.  They need to be honest with you and share.

This builds mutual trust, and everyone is more relaxed and performs better under these conditions.  Choice of PM box is something that you can also discuss, but unless you are very athletic there's not a huge amount between the vendors.

I really hope it goes well for you this time.  *If* you feel able, and willing, please share the outcome!

Best wishes.

Do you have confidence in your new doctor

by Gemita - 2020-03-09 07:44:34

who is about to undertake lead revision Christopher ?   We have to trust our doctors and work with them to ever have any hope of a good outcome.  If there is the slightest doubt or lack of trust on either side, then I would respectfully suggest it might be better to delay lead revision or an upgrade of any kind and find another doctor with whom you can place your complete trust and feel more reassured.  (Someone with more experience and a good track record of success with lead revision/pacemaker upgrades perhaps ? - Maybe another opinion ?

On the other hand, if you do have complete trust and your new doctor has good experience in lead revision and you are only nervous (understandably) because of what you have been through, then I would answer your questions as follows:

You ask, "Will this fix the problem and will I come out of this okay" ?  I am not a doctor, but I would hope your problem would be helped by lead revision, otherwise why do it.  When you see your doctor you could ask him/her to explain fully how they will perform lead revision (for example will this mean lead extraction?).  I am not completely clear what lead revision entails.  We know lead extraction is potentially more risky in unskilled hands or in patients who have had previous complications or with certain health conditions.  

I would imagine the general anaesthetic would allow your doctors more scope and time to manipulate your leads without fear of causing you unnecessary discomfort or alarm during the procedure, or without the need to top up any local anaesthetic should the lead revision procedure take longer than hoped.   I would ask your doctors how long they anticipate the procedure will take?  I had a general anaesthetic for my pacemaker surgery and I was happy not to be aware of the procedure.  I was also told it took longer than usual and a general anaesthetic was their preferred option for me.  Often depends on EP and patient's preference I would say.

You have a few questions you really need to be asking your EP before Friday.  Time to be open, honest and clear about what you expect from any upgrade and whether your expectations can be fulfilled by lead revision of your present system, or whether a completely new pacemaker system is possible or even necessary??  I am still learning Christopher but I would imagine that OPTIMUM LEAD PLACEMENT "POSITION" IS THE ESSENTIAL HERE to overcoming your present difficulties, rather than focussing on a change of Pacemaker brand.  

Anesthesia During Pacemaker Implant

by Marybird - 2020-03-09 15:03:33

First of all, Christopher, I wish you the very best with your pacemaker and lead replacement on Friday. You've gone through enough with your previous experiences for several lifetimes. I hope you can have that serious talk with your doctor to express your concerns, and get explanations that will reassure you that all will be ok. And that it all will be ok.

Crusty, I can't even begin to imagine having to go through the hassles you did with your lead placments, especially with only a worn-off local anesthetic. Why in the world would your doctor and team not give you at least some conscious sedation to lessen your misery as they worked on you???? I think it's got to be almost the worse thing you can hear when you realize things aren't going well, and hanging upside down(!?!) hearing your surgeon's swearing as commentary on how lousy the situation is. Well, maybe hearing "uh-oh" would be worse, but it seems a wash to me.

They told me the EP who implanted my pacemaker has a general policy for all his patients to be put completely under for pacemaker placement. I learned that this was actually "deep sedation" where the patient is asleep and unaware of anything, but is still able to breathe on his/her own and there is no need for intubation. It's just a little more on the "conscious sedation" continuum with propofol and whatever else they use and they wake you up, and there is little grogginess afterwords. I know I felt nothing, was in lalaland during my pacemaker placement, though it was uneventful and easy according to my EP. And if he swore during the placement, I sure didn't know about it. 

Perhaps this is the type of "general anesthesia"  they are planning for you? I think in your shoes, with your previous experiences with pacemaker placement and afterwords, I'd prefer to be as unaware as they let me be. The specific type of anesthesia they plan is another question for your doctor. 

In any case, best wishes and hope all will be well now, for you both, Christpher and Domkin

Wusses ;-)

by AgentX86 - 2020-03-09 16:27:56

My EP (and he's not alone) uses only locals if he can get away with it. Two of my three ablations, AV ablation and PM implant,  and what was supposed to be a carotid stent (no stent needed) were all done with just Locals. One ablation was done with a mild sedative, then forgot to turn up the happy juice before cardioversion me. *THAT* hurt!

I had some pain when they made the PM pocket but it was bearable and the burning of the heart muscle during one of the ablations felt like someone was woodburning on my back in a few spots. The TEEs were, um, "interesting".

I'm happy I didn't have general anesthesia though. I hated the ventilator and there really was no reason. The procedures were fairly simple and completely uneventful.

"General Anesthesia" Could Be IV Deep Sedation with No Ventilation Needed

by Marybird - 2020-03-10 14:05:52

From the Wuss here, LOL. I haven't had all the procedures you mention, Agent, but I have to be grateful that the cardiologists I've encountered decided for me that IV sedation would be the thing to get me (like all their patients, unless someone has a specific preference) through their procedures. I didn't argue with them, figuring I'm happy to avoid even minor pain or discomfort when I can. Especially when I've had no repercussions at all from the sedation, and I'm not looking to win a "Tough Guy" contest either, LOL.

The EP that implanted my pacemaker apparently prefers his patients to be all the way out when he puts pacemakers or other ICDs in. The hospital personnel referred to it as "general anesthesia" when I went through the preop rigamarole. I asked specifically about that, asking if this anesthesia was at the level they'd use for general surgery, and was intubation used during the pacemaker placement. The nurse I asked said that no intubation (or mechanical ventilation) is used, that the sedation is similar to what's used for a colonoscopy. As I read, that's IV sedation referred to as "deep sedation" where the patient receives enough medication to fall asleep, is monitored by a nurse anesthesist, but can still breathe on his own so no ventilation is required. It's like the other forms of IV sedation, (ie, conscious, somewhere in between conscious and deep) in that the medication is administered while the procedure goes on and stopped at the end, and the patient is awakened. At least in my experience there was no grogginess and I was ready to go soon after I awoke. I had no side effects from this sedation at all, including no sore throat as there was no ventilation. I had this type of sedation also for a colonoscopy/EGD and two additional EGDs (had bleeding ulcers) and had no problems with it ever.

As I understand it many EPs use IV conscious sedation in addition to local anesthesia for pacemaker and other ICD placement, but in these cases the patient is groggy/in lala land during the procedure, but not asleep and  may still be aware of what's going on. My sister, and my daughter (seems pacemakers are a family affair here, LOL) had pacemakers placed under conscious sedation, and had no problems there either. Though my daughter  went out after apparently her heart stopped altogether during her pacemaker placement, and woke up afterwords in lalaland. 

I have had conscious sedation-the last time for a cardiac cath three months before my pacemaker, and I recall being in lalaland, feeling like I couldn't move, and most importantly not giving a darn what happened or what they did to me. But I was still more or less awake and aware. With the cath I remember feeling momentary sharp pain in my arm as the cardiologist fought spasms in my radial artery while threading the catheter through that region, then it stopped. I remember thinking how painful that was, or would be if I gave a hoot.  I think I could undergo pacemaker placement with this type of sedation, but I'm not sorry that I wasn't at all aware of  what was going on.

Friday 13thFrom surgery

by Domkin - 2020-03-14 03:36:31

I was wondering how you are doing?