What happens if atrial lead fails?

Atrial lead fails

by H van Dyk - 2023-04-15 16:30:28

In the past I was diagnosed with a so-called AV-block. This resulted in the heart itself generating a sort of backup scheme to keep the ventricles going. However, such a scheme produces a much lower bpm. I suspect this is what will happen if the pacemaker aborts.

Short answer: No, I don't think it will be "game over" if your situation is similar.

"Game over"?

by AgentX86 - 2023-04-15 19:48:06

No, not even close.  A dual-lead pacemaker is really two complete pacemakers with a link between them.  Under normal circumstances, the atrial half wenses the start of the heartbeat, then a timer starts to deliver the signal to the ventricles. After some time, if there is no second pulse, the atrial half ot the pacemaker will start the process. OK, this all assumes everything is normal.

Now, assume the atrial lead completely fails (falls into a black hole), the atrial pulse can't be sensed so the pacemaker doesn't know when to transfer the pulse the ventricles. However, remember that a dual-lead pacemaker is really two complete pacemakers.  If the ventricular half doesn't sense a pulse, after some time, it will also generate an impulse to the ventricles. At this point, the atria and ventricles will beat out-of-sync (dyssnchronous) but that's not critical.  Many live will with this situation permanently.

The short answer is that your heart will still beat, though some features may not work optimally.

Even if your pacemaker fell into the above black hole, there are other pacemakers in your heart that will very likey take over. The ventricles themselves have such a backup.

atrial lead and av block

by Tracey_E - 2023-04-16 10:36:03

If you have av block, the atrial lead is probably just sitting there monitoring and not pacing, so nothing would change. 

You will be fine

by LondonAndy - 2023-04-16 18:42:40

I am 100% paced following "surgical complication" when I had my aortic valve replaced. Because this complication is known as a possibility, they put in an "exterrnal pacemaker" when they do the operation - ie wires attached to the heart that lead out of the body to a pacemaker box with knobs where they can turn things up and down to make adjustments. Whilst in hospital recovering from the valve surgery, each day they would come and twiddle those knobs to see if my heart had recovered its natural beat. One day I remember waking up being pushed back into the chair by two surgeons, as they had dialed the knob down and I had passed out. The conclusion within a week was that my heart had not recovered, and so I would need a pacemaker.

Like you, being told "pacemaker dependent" I thought if it failed I would be no more. Roll on to October 2022 (8 years after original surgery) and it was time for the original pacemaker to be replaced with a new one. Before the operation began the surgeon said I would most likely have an underlying rhythm, and sure enough as I lay on the operating table under local anaethetic, aware of everything going on but not feeling anything, he suddenly said "right, the old pacemaker is now completely disconnected - your heart is still beating". This was useful, as it made the operation easier for them. So as AgentX86 said, you still have a beat, just not a good one.

Av node ablation and PM dependent

by Shementush - 2023-04-20 14:38:55

Dec I had my AV node ablation. EP burned for 18 seconds the branch of HIS to make sure I don't have any escape rhythm. I begged him not to in advance to get a plan B in case of failure. In fact I used him for his promise to try to save my HIS. That's the slow 20hr plan B if one's PM malfunctions one doesn't have a game over. He tested it down to 40hr and found no escape rhythm after the 18 seconds burn.

So I too am concerned. Metronics had two recalls just a month before my PM implant. My heart relays on a computer chip from not failing? I had a lead failure noted during an interrogation on 8-21. I wasn't concerned because at the time I had a working AV node. But it's different now. My PM is set to 80hr. During recent times of SOB I see my hr around 75. Its trying to beat. I was sent by ambulance a month ago for angina and the EMT with his finger oximeter clocked my heart rate at 45. Obviously it must had been in error but it didn't make me confident.

Lower rate limit.

by PacedNRunning - 2023-04-23 05:04:38

If the atrial lead were to fail your ventricles would pace at your lower rate limit. Most have a lower rate of 60bpm. So your ventricles would beat at 60 and the top would beat at its own rate. There are many many timers. One being the V-V timer which is your lower rate limit. That timer will keep you at 60 if no atrial beat was seen by the pacemaker. Hope that helps. I 100% rely on every beat and most hearts have a back up escape rhythm. But again, the PM will picnic with the.V-V timer. There is also a A-A timer. Again many timers. 

Reassuring feedback...

by John_W - 2023-04-23 17:32:48

Good to hear two things...firstly the device will still drive the ventricles if the atrial lead fails and secondly I should have an escape beat of some sort. Early days for me with a pacemaker and I am not helping by overthinking the whole thing and asking myself all sorts of questions. Thanks to all the folk on this forum for responding to newbies such as myself. It really helps to hear from such experienced people. Whilst no one can fix the condition it does help massively to hear from others who are living their lives to full effect. Thankyou. John.

reassuring

by islandgirl - 2023-04-27 00:51:17

I am 100% paced on all 3 leads with an ICD--SSS and block.  I asked my EP recently if my lead fails will I be survive.  He said it is extremely unlikely the lead fails suddenly.  He assured me my heart would beat enough to keep me alive.