Displaced Pacemaker

I wrote previously about my pacemaker moving closer to my underarm.  Well this may seem like a silly question but at my age I think I'm due a silly question ever so often.  Are all leads the same length and would they stretch when pm moved to new location? Thanks.

2 Comments

It's more complicated than that

by crustyg - 2021-04-10 17:45:42

No, leads are not all the same length: apart from the obvious difference between leads for the RV and the shorter ones for RA, most vendors have two, sometimes three lengths for different sized patients.

More importantly for you: there is a bulge on each lead, near the PM end, that allows the lead to be fixed to the tissues overlying the point of access to the (usually) subclavian vein.  There is almost always quite a lot of slack between that point (fixed to your deep tissues) and the PM - you can often see a loop of spare lead under the PM on a CXR.  This loop provides some slack if the PM's anchor stitch fails.  Only if your PM pulls a very long way from the pocket is it possible for the PM to start to pull the leads outwards from the vein - and then take up the slack in your heart and possibly pull out of your heart muscle.

Having a PM move laterally from the pocket isn't that uncommon, but doesn't often result in a lead pulling out from the heart.  Lead damage, fracture, certainly possible.  Lead twisting if the PM flips over, again possible.  Pacing leads *never* stretch.  But there should be slack between PM and vein access, and again between vein access and your heart.  If there weren't any slack at this side, the first couple of heartbeats would pull out.

Apart from the inconvenience of having the PM getting in the way, and the risk of leads being twisted, having your PM come out of the pocket isn't a major problem.

Xray

by Tulp - 2021-04-11 22:31:29

As shown on my profile picture, the X ray shows the slack.  I guess they figured that out for us!

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