CRT lead implant failure

What a worry and disappointment

by Gemita - 2024-08-23 14:01:22

Tillyann, I am so sorry to hear about this.  Of course you feel shattered.  

Blockages in veins due to our leads are unfortunately not uncommon.  There are quite a few of us here who have experienced this difficulty. This can be a problem over the years if we continue to try to place more and more leads into an already congested vein, than that vein can comfortably hold.

Perhaps this was meant to happen, to prevent you from having worsening symptoms in the future from poor blood flow from any blockage which could have caused swelling of your left arm and elsewhere causing discomfort and other serious symptoms.  At least this way, your doctors are able to study your situation carefully and carry out all necessary tests to provide you hopefully with a permanent, safer solution.

Tillyann, please try to stay calm.  This will pass and you will be all the better once this has been sorted.  There are other members here who have had their pacing systems moved and I hope they will see your post and respond to offer support.

I hope your doctors keep you fully in the picture.  If you experience any symptoms from your failing battery, please let them know quickly.  There is no need to suffer in silence and you always have us to support you too.

I send you my very best wishes for a successful outcome.  

right-side implantation

by Julros - 2024-08-23 16:20:02

Hi Tilly, I am sorry you are having this set back with upgrading your device, but it sounds as if your doctor is exploring all the options. I am not sure which vein is causing your issues-- do you mean the subclavian vein that carries the wires to your heart? Or the coronary vein on the outside of your heart, that they normally thread the LV lead into? 

I have not had difficulty with placing the LV lead, but when I had an upgrade to and ICD, I had known subclavian vein stenosis. Before the procedure, my doctors discussed using a laser, or moving the device to the other side and tunneling the lead. Fortunately, they were able to use a cutting catheter to reopen my vein to remove the RV lead and place the ICD lead. I have also heard of placing an epicardial lead, that is, on the outside of the heart, although I think this is rare. But my point is, there are options. 

I found this paper on challenging LV lead placement. Its rather technical, but perhaps it will show you that your issues are not unheard of and there are techniques for overcoming them. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244170/

Best wishes, 

Julie

Hugs. So sorry

by Lavender - 2024-08-23 16:45:43

I'm sure this is so difficult. I know you were understandably concerned to go through the process to begin with and here now to have a complication-how worrisome!

We do have other folks who have their devices on the other side.  Others had occluded areas. They made it through and posted here, so I know this is doable. 😉

Julie's article says:

One of the common challenges encountered during the implantation of cardiac implantable electronic devices (CIEDs) is stenosis and occlusion of the venous system in the thorax. This is more relevant during an upgrade procedure with the addition of LV leads in patients with preexisting device systems. It is estimated that 10% to 30% of patients with existing CIEDs have stenosis or occlusion of the axillary and subclavian venous system.8 This finding often leads to abandonment of the procedure, implantation from the contralateral side and tunneling of the lead to the existing pocket, or referral for surgical epicardial LV lead implantation. 

The article is about four years old but it lists other options to resolve this problem. Your medical team will figure this out. It's good that your old device could still serve you a bit longer until you can be fixed properly. 

I can only imagine your dismay. May God walk alongside you with comfort and the peace that surpasses all human understanding. May He inspire your caregiver team with the best possible ways to achieve an optimal outcome. 
 

Vein stenosis

by Amyelynn - 2024-08-23 21:39:13

Hi Tilly

i have a duel chamber pacemaker and both the leads failed. The doctor tried to place new leads on the same side (left) but couldn't get them to pass so he abandoned those leads and put new leads and generator on the right side.

if I knew everything I know now I would have insisted that he extrac those old leads (because now I am geting them extracted in two months and they are 26 years old and cause SVC syndrome)

please ask about lead extraction if those two leads are old or not working great (if that's an option for you) but only with a highly experienced doctor. 
I don't know much about the CRT their lead placement but possibility out can go on the other side I hope.

please keep us posted how you are doing and what the plan is moving forward and try to stay positive yet informed. Ask questions!

amy 

Dad is in the same boat…

by Elebele - 2024-09-08 13:38:11

Hello, My dad is in the same boat as yours. His surgeon just ended up changing his pacemaker a few hours ago, he's still intubated. I am heartbroken over this now. Please let us know how you're doing now if you have some time.

tunnelling for 3rd lead

by islandgirl - 2024-09-14 01:08:47

When I had a 3rd lead added, the EP had to tunnel across my chest to the right side.  When I had my CRT-D replaced about a year ago, I went to a cardiothoracic surgeon and he said he could have done the lead insertion without tunnelling, as he could have opened up the veins.  Recovery was painful for a few days.