Lead voltage

leads

by Tracey_E - 2024-04-08 17:00:09

A lead can be easily repositioned in the first year. After that, it has to be extracted with a laser, or take up space in the vein adding a new one. Neither is ideal, is there a reason he doesn't want to fix it now? You might want a second opinion.

I've had voltage increased when a lead went bad. The device lasted me less than 3 years. The only downside was the shortened lead life. The heart wasn't getting shocked harder, it took that much more juice to get it to pace. The analogy they gave me was running the air conditioner with the window open. The house still cools, but the power bill goes up. 

Yes..

by USMC-Pacer - 2024-04-08 17:09:27

They increased the voltage on my damaged lead but it was very temporary.. like 2 months until they could get me in to replace everything. At the time, I had a year left on the device. I would request the old lead be removed. It's going to have to come out at some point. The longer they leave junk in there, the tougher the procedure will be later. JMHO

Hello stranger

by Gemita - 2024-04-08 17:21:30

Where have you been Lavender?  Have been missing your posts!

Thank you for the update.  I wonder how quickly the high voltage will wear down the battery?   I am glad you won’t notice the increased voltage.  I wouldn’t want to get any diaphragmatic pacing sensations or hiccups from the higher voltage.  They will be keeping a close eye on you but do let them know if you start getting symptoms and keep up the pressure to have the lead replaced if you do get symptoms Lavender.   I have read about members having their lead voltage turned up to 5+, so you still have a little way to go. 

We have been watching the total solar eclipse pics on TV - that halo around the moon is awesome.  Wish we could be there.  We have witnessed one over here, I think in 1999.  

Lead

by Lavender - 2024-04-08 17:36:15

The cardiologist didn't put in the device three years ago, the EP did. I do have nightly monitoring. The cardiologist will see me in person in six months. I asked him six months ago about replacing the lead but he said that more battery life must be used up beforehand so insurance covers. He feels that since everything is working ok, I can go another six months and recheck. 
 

Tracey: I am glad the heart isn't getting shocked harder. He said there's nothing to be concerned about at this point. Of course, I immediately felt some anxiety. I told him I am not afraid to die but I don't want to suffer at all. 😑 

Gemita: I have had a lot going on. My mom passed away March 13. Up to that day, my visits with her at her memory care facility greatly increased. She died of breast cancer at age 98. I am happy she's finally set free after nine years in facilities and probably four years under hospice care. I also have had some family with other issues so I am hoping things calm down. 
 

You can bet I will call the cardiologist asap if I am symptomatic. When he told me about the lead six months ago, I did call him the next day for further information and explanation because it made me anxious thinking a lead will fail. 
 

There is some comfort in hearing that others have high voltage settings, Gemita. I'm just unhappy that three years ago all was well. I don't know if tissue grew over the lead obscurring the signal or if the lead moved. I'm just guessing. In any case, here I am so must deal with it as it comes. 

Such sad news

by Gemita - 2024-04-08 19:30:30

Dear Lavender, I am so sorry to hear the news about your Mom, bless her.  I hope she passed away peacefully.   I will write privately tomorrow.

I cannot really understand either what might have happened.  I know the left lead can be tricky to implant, but I see it is your right lead that is at fault. 

Some long term causes of capture failure include lead fracture;  breach of insulation;  fibrosis/inflammation;  cardiomyopathy;  myocardial infarction;  scar tissue formation or calcium crystal deposits at the lead tip, preventing myocardial stimulation but this has been nearly eliminated with the use of steroid-eluting tips.  

Non cardiac long term causes capture failure include Electrolyte imbalances like Hyperkalemia;  Acidosis or Alkalosis caused by imbalances acid/alkaline base in blood;  Hypoxemia (low levels oxygen in blood) or Hypoxia (low levels oxygen in tissues) and some medications may adversely affect the capture threshold significantly and lead to capture failure too but I don’t think you are taking anything.  However, I recall you needed hospitalisation and antibiotic treatments for an acute condition within the last year, so I don’t know whether some inflammatory, viral, infectious process has caused damage/scarring or other problems, possibly affecting your leads?

Of course it is possible that something else occurred with your right lead much earlier in the post implant period - say within hours to weeks following implant and is only now coming to light.  For example malposition of lead or premature lead failure.  In your shoes, I too would want to know why the lead has failed, although it is probably a loss of time to keep asking why when it just needs fixing as soon as possible. 

Until tomorrow, goodnight Lavender.

🌸

by Lavender - 2024-04-08 20:56:29

Gemita,

Mom passed softly. She never suffered til a few days before death. As soon as I was aware of her pain, I had hospice initiate morphine and Ativan. Mom had a couple quiet days wherein I spoke to her at length in peace as her eyes were closed. Mom hasn't known anyone in a couple years. She had a very long blessed life. She was a tough mother but softened as dementia set in. She went from angry and critical to loving and pleasant the last few years. It was very healing for me. 

Thank you for all the insight and ideas on why a lead can be suboptimal.  At this point I no longer question, the cardiologist said there can be many reasons. As I tell my sons often-we cannot go back, only forward.

I was indeed hospitalized a few times in the past year. I had anaplasmosis from a tick bite, and was treated with strong antibiotics, but that was after the lead issue was discovered.  I don't need or take any medication. I never had covid but had RSV in February this year.  

I had several chest xrays over the past years and was always told the pacemaker and leads were fine.  I guess it could be tissue scarring, who knows?

The cardiologist is confident that my nightly monitoring will keep a good eye on things. He said there's no concern. Easier said than done to not be concerned. 😉

I hope others here will let me know if they have voltage this high and for how long. As Tracey said, hers was turned up until battery replacement and USMC-Pacer only had it turned up a short while until replacement. With my total dependency on my device, it's a bit disconcerting and I wonder how often voltage is turned up to buy time. I also wonder if you have any issues with a higher voltage, although the cardiologist says I won't notice anything. 

Thank you Gemita

by Lavender - 2024-04-09 10:30:02

Gemita sent me some very helpful past posts from 2011. I do think this is an insurance driven temporary fix. It makes me angry. I will be very observant as to any symptoms of change. At my six month recheck in October, I won't permit any further voltage increases without a second look by my EP. My cardiologist works very closely with my EP, and I do trust them both. 
 

From Electric Frank:  The only thing I would add is that the situation is very unlikely to improve by waiting. If the lead is not making good contact, or is located in unresponsive tissue it isn't going to get better by itself.

I can't back it up, but have often felt that the "wait and see" approach is to get past the time where an insurance company expects a problem to be corrected as part of a "warranty" situation. If they can delay past that time it is considered a new procedure and will be paid for.

From dezineit:  So in order to make up for the current differential, all that can be done without physically moving the lead into place again would be to increase the voltage output. 

From Selwyn:  Do have a lead problem.  I need an increased voltage to reach the threshold level for venticular contraction. This does produce an abnormal drain on the battery. However, in my case, I am not paced that much with the venticular lead. The other thing to look at is impedance of the lead as this will change as a measure of electical resistance. 

Any sudden changes with voltage needing to produce a contraction of your ventricle indicates a lead problem ( from PM to tip of the lead in the ventricle) in my mind.  My slight lead problem is being left alone.

High voltage setting

by Gemita - 2024-04-10 01:53:32

Lavender, your question:  anyone have their voltage increased? I'm wondering just how high they can turn it up ⚡️??

I had a quick look in my Medtronic manual and found the following which is extremely clear:

Right Ventricular Capture Management – does not program right ventricular outputs to values greater than 5.0 V or 1.0 ms. If the patient needs right ventricular pacing output greater than 5.0 V or 1.0 ms, manually program right ventricular amplitude and pulse width.  If a lead dislodges partially or completely, RV Capture Management may not prevent loss of capture. 

I had a quick look for Boston Scientific and found the following link which seems to indicate max amplitude of 3.5 V to 5.0 V too, although if you consult your own manual you should find a simpler answer for your particular model:

https://www.cardiocases.com/en/pacingdefibrillation/specificities/pm-pacing-sensing/boston-scientific/pacing-sensing-boston

- throughout the threshold measurement, a backup pacing is systematically delivered after the first ventricular pacing (70 ms after the primary VP) at a maximal amplitude of 3.5 to 5 V to prevent any ventricular pause as a result of loss of capture.

Hope this answers the fundamental question on max programmable voltage, with anything higher perhaps requiring a manual adjustment of right ventricular amplitude and pulse width.  I don't know how high this can be manually set without causing uncomfortable symptoms?  A question for your Cardiologist/EP if they are intent to wait to replace the lead.   A new lead sounds the best solution!

Angry that Insurance is a Deciding Factor

by SeenBetterDays - 2024-04-10 07:28:26

Dear Lavender

First of all, I am so sorry to hear about the passing of your mom.  I am glad that you were able to spend some precious time together at the end of her life which will have been a blessing for both of you. I am glad that she passed peacefully and with loving family.  I think that is something we would all wish for when the time comes.  I am thinking of you.

I am so infuriated by the insurance situation which, in some instances, seems to be prioritised over patient care and safety.  It seems from what you have described that your lead should be replaced and sooner rather than later.  I am also pacemaker dependent so understand your natural anxiety at hearing that your voltage needs to be increased.  I hope they will be keeping a close eye on you for any changes in the next few months and that you are able to get the surgery that you need in a timely way.  It is very difficult not to worry even when told not to do so.  I also share your issue with lead testing so know that this won't be something you will find easy but I have been told that when it gets close to battery change or they notice a specific problem with impedence there is no avoiding it.  Hopefully, they can perform the checks for you in the most gentle and controlled way possible so that the impact on how you feel can be minimised.  I really feel for you Lavender and hope that you will continue to have close monitoring over the next few months.

Sending you much love.

Rebecca x

Thank you

by Lavender - 2024-04-10 09:40:42

Gemita,

I am always amazed by the depth of your knowledge and research! I so appreciate knowing that Boston Scientific has a max of 5.0.

I called the cardiologist today for more clarification of his decision to wait. I want to know if it's common to proceed in this manner. 

I was told that I would get a callback tomorrow as they're not in the office today.

Seenbetterdays,

Yes exactly! I feel such dread and discomfort when the right lead is tested. My cardiologist said, as you did, that eventually we need to test it. I told him to go ahead and he said not now. I expect it's because last time it was tested, he couldn't find a pulse on me as I was near syncope from the test. 
 

Thank you for your sympathy. Mom's passing was a relief. It was time. As I age, I realize that it won't be long til we are reunited with loved ones. 

Cardiologist response

by Lavender - 2024-04-12 08:40:46

I got an email back from the cardiologist office. I was told that this voltage increase is what I need at this point in time. So I'm trusting his advice and will stop questioning. His reputation is stellar.