3rd Time Around


Hi folks,

I'm getting my 3rd PM (coated 2 lead) in about 2 weeks. You may recall my other 2 implants had to be removed because of either infection or allergic reaction. It's still unknown what the true cause of the inflammation and erosion was.

In case my problem was an allergy to titanium, the new one will be coated in a hypoallergenic material (PTFE?). So that's 1 big worry out of the way.

In case my problem was bacterial colonization, the the surgery will be done in the OR by a cardiac surgeon, not in a cath lab by a cardiologist this time. That is because of better sterility control. My surgeon wants to implant the new PM more deeply under the pectoral muscle. He says it will be less likely to become colonized than a shallow implantation, which makes sense.

Well, guess what? My cardiologist is at odds with that decision. He is afraid a deep implant could also become infected, causing a deeper, more serious infection than my 2 previous "infections", if they indeed were infections.

My question is, has anyone had to get a sub pectoral implant because of low grade infection (or any other reason)?

Any bits of knowledge on this subject is greatly appreciated. I have a decision to make in 2 weeks.


Many many thanks,,,

Bob A.

4 Comments

buried

by Tracey_E - 2008-10-30 03:10:24

Mine is what I guess you could call the girl version of subpectoral- it's submammary. It's so deep I can barely feel the edges of it if I poke around looking for it. It was done for aesthetic reasons, not infection. I'm on number four and have never had a problem with infection.

Can they use the aigis envelope? (ad on the left)

All of my pm's have been by a cardiac surgeon at the hospital. I thought they were all done that way!

I'd trust the surgeon and tune out the cardiologist. He still has no clue what happened the last two times!

So, does this mean the wound(s) are healing well? I sure hope so. I've been thinking about you, wondering how you're doing with out it. GOOD LUCK!!!!

Aigis Envelope

by bobad - 2008-10-30 06:10:18

Tracy,

I mentioned the envelope to my cardio, and he acted as though he had never heard of it. I told him what I knew, and he rejected it out of hand. He remarked that my first implant didn't become inflamed for 3 months, so it wouldn't help except to prevent initial infection.

I think there are definite benefits to cardiologists and EP's doing PM implants. They do high volume, and become fast and very expert at their specialty. Actually, I'm a little more nervous about the surgeon, partly because his team may not be as expert with the milder sedative and the lead placement.

My orignal (left collar bone) wound appears 100% healed, but is still sore. My right side one was huge, and too wide to stitch. It had to "heal from the inside out", and you could have literally stuffed a golf ball into it. It's now around 80% healed. My dear wife did a wonderful job of scrubbing up every night and packing the pouch with sterile gauze and Bunnell's solution. It appears that 2 more weeks and it will be totally healed.

Heart is up and down. SSS is an unpredictable animal, and does it's own thing. I can't take my full dose of Metroprolol for the tachy, because it will send the brady too low with no PM. So I'm wingin' it. :)

Thanks for the info TracyE, it was most helpful.

suspicion

by Tracey_E - 2008-10-31 05:10:46

Call me paranoid, but I'm always leering of doctors who dismiss things out of hand! How else do you learn about the great new stuff coming out?

My cardiologist refers all pm's to the cardiac surgeon because he IS the expert in lead placement. I've never been to an EP, I like my cardio just find and can't see a reason to change this late in the game.

I'm so glad to hear the wounds are healing! I can't imagine a hole that big, OUCH!!! Kudos to your wife :o)

Pacemaker Allergy

by 60bpm - 2008-11-03 08:11:06

Hi Bob,
I was really surprised to read this post from you. I too just was diagnosed (by St. Jude) with the ever so rare pacemaker allergy. My 2nd PM is starting to breakdown despite the dacron pouch. Inevitably, I will have my 3rd pm implant before too long as the burning pain, indicative of the corrosion is just starting to take hold.
I plan to see the head of EP on Nov 25 to see how they will proceed with my case. My EP said they are leaving it up to me based on how I'm feeling. From what I've read, the two case studies from ( Japan and Mayo) both indicated success with PTFE coating. I am hopeful that this will take care of the problem for both of us.
Good luck Bob, let's hope the 3rd times the charm :)
Diane

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