Successful surgery

Hi All

 

i had my lead extraction (4 leads), two new leads placed (left bundle) and new generator put in on Nov 5th at Cedaf Sinai in Los Angeles by Dr. Raymond Schaerf.

they accessed through both femoral arteries (1. For temporary pacing the other for a camera I believe or just access to the heart)

Surgery took about 5 hours from the 2-3 expected. Some procedure notes: ( ‼️ WARNING ‼️ may be too graphic for some )

"She was placed asleep but did require a femoral artery line because her radial arteries were not suitable for an art line."

"The patient had some dense calcification throughout the pocket making it somewhat difficult to dissect the tissue..."

"We then dissected out skin, subcutaneous tissue, pectoralis fascia, and pectoralis muscle leaving his with a defect of 12 x 8 cm."

"We now turned our attention to the left side and found even more scarring calcification in this pocket. At times the only way to get through the tissue was to crack it with a clamp."

"We now cut both leads we were able to pass an interlocking stylette into the right ventricular lead and secured this with a Cook 1 tie. This lead was seen not to have any retraction of the fixation screw on fluoroscopy. The atrial lead did not except the stylette and we were forced to use a Cook bulldog which was secured with a Cook 1 tie. This lead also did not allow us to retract the fixation screw. We began by using an 11 Cook Evolution RL but found significant resistance and switched to a short Evolution RL. This enabled us to get into the distal innominate vein. With a great deal of difficulty we now used the 11 Evolution RL and were able to remove the ventricular lead. The patient remained stable throughout. atrial lead which did not have an interlocking stylette all the way was rather difficult to get. This required passing the short Evolution and a long Evolution but ultimately we managed to free the lead up and remove this lead without issue"

 

sorry if too much details I find this all interesting.

post op was really hard for me (not the best staff I woke up to) thankfully the overnight staff was great. I left the following day.

i am now home and dealing with some difficult with recurrent nausea, HR abnormalities (HR climbing to 100-130s when doing nothing) one point I was laying in shallow bath and I felt my chest pounding so tested my HR with my Apple Watch it was 134 then almost immediately dropped to 60 (my resting HR) also a lot of fatigue and I am not pushing it (and prior to this very healthy 38yd old active woman) 

any input on this? Is this what afib feels like? I have never dealt with this before. Think my body is just healing? I asked for same settings on pacemaker but this model is newer (maybe some settings are off/ diff/ new?)

also saw in my online chart listed under implants "Sealant Recothrom Floseal 5ml" listed as in my heart. This seems to be some kind of glue to stop bleeding and says your body evaporates it in 6-8 weeks? Anyone familiar with this? 
this it was placed where the roads came out of the heart? Would you ask for more detail?

follow up with PCP Tues and follow up with my at local EP 21st (will do EKG & ECHO also have orders for chest Xray) I am keeping notes about nausea, at times light headedness and abnormal HR episodes. 
 

ECHO prior to release from hospital showed 51% LVEF.  Said low/normal. When do they consider it low? 
 

hope you all are well!

still in shock he was able to get all four leads out!! 26 & 16 years old; YAY! 
 

Amy 

 

 

7 Comments

🤩 wow

by Lavender - 2024-11-10 19:14:30

I'm amazed at all you went through. Wonderful that they got everything out that was placed when you were only 12 years old. Now no more worry about if they could get the leads out. I'm impressed by your medical report and that although it took a long time and was certainly difficult, it was successful. 

Cleveland clinic says Ejection fraction in a healthy heart is 50% to 70%. So, although they list you as low, it's apparently still in the normal range. 

Any time they work on us, we have to heal and it might take a bit for the heart to settle down. Good you're seeing the dr in just two days! Good plan to write all symptoms down. Sorry you're experiencing nausea and lightheadedness at times. Your body has been through a lot so hopefully it will ease up. You sound good. Lol so your attitude and enthusiasm will be sure to carry you along the healing journey.  

Thank you so much for your feedback on this complex situation!  Godspeed your recovery and get you back to your usual activities soon!

thanks for this update to your procedure

by new to pace.... - 2024-11-10 20:31:54

with much rest and of course remembering to stay hydrated you will soon be yourself again.

new to pace

Wow, what a procedure!

by Gemita - 2024-11-11 08:33:37

Amy, firstly wonderful news to know that you are safely through your procedure.  Thank you so much for all this information that I am still going through.  The calcification issues seem to be quite common, although “cracking it with a clamp” sounds rather alarming.   I am not surprised that you are suffering after your long procedure and it can only get better.  I hope you will not have any major pain or extensive bruising from your femoral artery access site and I am sorry that they were not able to use the radial artery which might have been kinder.

I wouldn’t try to diagnose a heart rhythm when you have just been through so much.  You might be experiencing all kinds of different arrhythmias, including Atrial Fibrillation (which for me is a quivering sensation in the chest causing me to feel quite wobbly and not at all well).  Atrial Fibrillation can occur at a slow, normal or fast speed.  It would not be unusual for any rhythm disturbance to surface after a 5 hour procedure.

An ejection fraction of below 35% would be considered heart failure territory.  51% LVEF would seem perfectly normal to my doctors.  You need to wait for your heart to heal before trying to assess how you are doing and with a new pacing system, it will take time to accurately measure how well you, your heart and your pacing system is functioning.

I hope you will be delighted with your new device once you have healed.  Take good care Amy and I am so glad you are safe xx

Edit:  Not quite the same, but I had an angio-seal vascular closure device inserted (right femoral artery access site) to help prevent bleeding from the femoral artery.  Was told it would be fully absorbed within 90 days of placement. 

You were in my prayers

by IrishToast - 2024-11-11 09:43:15

So glad to hear you're back and recovering. Your heart and vascular system I am sure are reacting to all that it went through. Perhaps the sealant can cause nausea as it dissolves into your bloodstream? Staying well hydrated will also help eliminate toxins.

What a Relief

by SeenBetterDays - 2024-11-11 12:01:39

Hi Amy

So glad you got this procedure over with, it sounds like quite an ordeal.  It's no surprise your heart is a bit disturbed by all that you've been through. Although the symptoms you describe sound unpleasant, fingers crossed that given time your body will start to heal and your heart rate begin to settle.  I am not sure of the settings protocols for LBB pacing but I imagine that you may need some adjustments when everything is a bit more stable to maximise the result for you.  Thank you for giving us such a full description of your procedure, it's great that you can share this so we can all learn from each other.  I really hope you're feeling better soon and can start to enjoy normal activities again.  Keep us posted.

Great news!

by Tracey_E - 2024-11-11 12:06:26

Thanks for the update and so glad to hear it went well! 

Are you on pain meds? They all make me nauseous. Can they give you something for the nausea? Have you tried something otc like bonine (nondrowsy dramamine)? It's intended for motion sickness but they are anti-nausea meds. 

EF over 50 is good. I wouldn't worry too much right now, your heart has been through a lot. 

Can I be nosey? Feel free to message me if you prefer, or wait until you feel better, no pressure! Did you travel home after discharge or wait a day or two? Did they put the new leads on the same side as the extraction or the other side?

Sending healing energy your way! 

 

Best Wishes

by Julros - 2024-11-11 17:26:04

Thank you for the update and sharing your operative notes. 

I had a lead extraction 2 years ago, but not nearly as long. I felt poorly for about 4 days and just allowed my self to rest. I attribute much of my unease to the meds give prior to and during anesthesia.

Keep a close eye on your femoral wounds, as I developed MRSA, that didn't show up until a bout 3 weeks after the procedure. This was despite using the antiseptic soap beforehand. 

You know you're wired when...

You have a little piece of high-tech in your chest.

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