Lead reposition/replacement and symptoms

I am new to all this and do apologise that my post is longish. I had bradycardia in the low 30s with 3 to 4 second pauses, and occasional atrial fibrillation. A dual lead Boston Scientific pacemaker was placed 4 weeks ago intended for atrial pacing, with ventricular capture only if necesary. However I now need to go in for a reposition or replacement of the RV lead because it has been showing increasing voltage at each check since my surgery (now doubled since insertion).

I have some questions:

-Firstly, how complicated is the lead replacement procedure? The cardiologist has not explained it to me at this point. 

-With any increase in my heart rate (even to 70 or so), my heart beats strongly with a throbbing senstion such that I might have felt in past if had climbed a steep hill with great effort; this extends into the base of my neck as well. Is this perhaps to be my new "normal"? I would appreciate some input.

-Most distressingly, I have had intermittent episodes of a sharp and uncomfortable tapping against my chest wall (in time with my pulse) lasting up to a minute, and with increasing frequency as time goes on.

Has anyone else experienced either of these two issues? I am wondering if malposition of the lead could be responsible for my symptoms.

4 Comments

My guess...

by crustyg - 2024-10-08 02:52:31

..is that 'reposition' will probably be fairly easy, as there shouldn't be much scar tissue build up around the lead-to-heart muscle.  Undo the little helix that anchors the lead, move the tip and re-anchor, check capture voltage and impedance.

Tapping against your chest: I suspect that your RV lead is stimulating some tissues outside your heart, partly because the pacing output voltage is so high.  Even if the pacing is *only* activating the RV a high voltage can feel unpleasant.  We've recently activated my RV lead and it was quite a thump in the chest - RA pacing I can't feel at all, as it should be.  The EP-techs reduced my RV pacing voltage, and doubled the pacing width to achieve reliable capture and that helped a lot.

Get your PM reports (which includes your settings) and have a look at the RA and RV pacing outputs, they may have been very different.

Tapping

by PortCityPacer - 2024-10-08 10:33:31

I too have a Boston Scienctific dual chamber PM. I started experiencing that "tapping" the day after implantation, wasn't sure what it was but it scared me and my HR would jump up. A reprogram helped but I was still having the tapping so I started keeping a log. I discovered that mine happens on the 56th minute of the hour, every 21 hours. I searched the web and it brought me to this site where I found the answer. Another club member advised me to download the technical manual for my PM, once I did I did a text search for "21 hours" and got 11 references in the manual. There are several tests, including checking the leads for conductivity, that the BD PM performs every 21 hours. To me the tapping is uncomfortable and often wakes me at night. It may be something we have to live with but I've only seen a few complaints so maybe it can be "tuned down". I go to my EP next week and I'm prepared to ask her about it. Hope this helps you a little.

If it's every 21hrs then it's the auto-calibration

by crustyg - 2024-10-08 11:13:32

Boston Sci run their automatic capture threshold every 21hrs, and because it can only run by using a much higher pacing voltage and then reducing, many patients can feel this.

I charmed my EP-techs into disabling auto-cal - my lead impedances are very stable and the pacing output is over, or well over 2 * capture threshold.

Yours may also be willing to turn off auto-calibration.

Lead voltage and replacement

by Spinner - 2024-10-08 14:50:04

Thanks to you all for the information and advice. Yes, I do believe that I am experiancing the auto calibration, but also the other frequent tapping makes me think that the issue does relate to stimulation outside my heart. Perhaps this is due to placement ? and will be corrected with reposition...I hope that this is the case

. 

You know you're wired when...

You get your device tuned-up for hot dates.

Member Quotes

I can't wait to give my son a run for his money again in the park again.