Alternate lead placement

Leads

by Lavender - 2024-07-26 22:28:57

I have a lead that is not optimally placed. It requires increased voltage as a safety net. I was told that I have to wait for the battery to wear down further before a lead revision and new pacemaker. Mine is three years old and I was told by the EP at insert that he had trouble with one wire. 
 

You have only had your pacemaker two years and they're already replacing the wires! I'm seeing my cardiologist in October and will discuss with him what you mentioned about nonconventional placement in my case. I don't feel anything bad but I do feel concern in waiting to get a repair. 😉 So I don't think changing things will make me physically different just perhaps more peace of mind. 
May all go well for you!

Placement

by karensoftball - 2024-07-26 22:38:02

I am on my first pacemaker. My placement is traditional for the atrium and left bundle branch for the ventricle.

I have no comparison to make, but I have no complaints being paced. My EP was strongly hoping that they would be successful at doing this. He said it would be the best for me.

Thanks guys!

by Mae11 - 2024-07-26 22:53:24

I've actually had my pacemaker for just over three years.. initial implant was June 2021. I experienced diaphragmatic stimulation immediately after and had a revision of both leads, and was told placement was difficult with limited areas..

For nearly a year now, we have questioned whether my RV lead had perforated because of pectoral muscle stimulation. My voltage has also increased dramatically, so the lead has been turned off because of all of this..

I'm excited and a little anxious to see how it goes and I'd he's able to use the unconventional sites as planned.. also on the fence as to whether this has to do with the recurrent pericarditis and if I will be able to stop the Arcalyst injections.. 

One step at a time!

Hope all goes well

by Gemita - 2024-07-27 04:57:28

Mae, I would say you are very successful in getting your technical data.  The exact position of my two lead tip placements are not available on my usual data downloads sheets, but they were confirmed on my initial Pacing Check summary sheet. 

My right atrial lead has been placed in the right atrial endocardial area and my right ventricle lead has been placed in the right ventricle septal area, which is slightly better I believe than the usual site, right ventricle apex area.  Conventionally, right ventricular leads are placed at the apex, but increasing evidence suggests this strategy may have deleterious effects on cardiac function and cause dyssynchronous ventricular contraction.  

My right atrial lead position is common for many of us I believe, but the right ventricle septum position is slightly improved on the right ventricle apex area.  Optimal positioning of the lead tips is key to successful pacing, but of course good placement is not always easy to achieve and will depend on so many factors, sometimes beyond the control of our surgeons.  

The patient’s body habitus which as we know refers to the common variations in the shape of the human body for example, might make it difficult to achieve a satisfactory placement in some cases and suffering from Ehlers Danlos like you Mae, some of my internal parts are subject to prolapse/atrophy/movement and other frailties so optimum placement is even more important.

I really wish you well and hope that you will start to feel better very soon in all respects xx

Lead Placement

by Amara - 2024-07-28 18:43:41

I just had a new PM placed. I have the same RA lead and a new LBB lead. I previously just had the RA lead. I've only had it a few weeks, but it seems good to this point. I'm pacing 15% from the LBB lead and 100% from the RA lead. 

The EP checked the RA lead and said it was fine. I've had some issues with it since implant so I hoped he would extract it and implant another with a better location.