Pacer leads still in...Ouch!

[ElectLive]

Scott - Don't hold me to this, but I remember a few things that I happend upon a few months ago when doing my own research on permanent pacemaker leads:

For temporary leads, there's generally a protocol in place to establish, among other things, when to remove, acceptable INR, how to remove, and how to monitor afterwards for complications. In cases of excess "tugging", I'm pretty sure it is standard procedure to do a slight pull and cut flush. Supposedly, subsequent removal is not required, and problems rare. Unfortunately, it seems that may not apply to you.

So, I think they are not strictly left in place just because a patient is on ACT. It's the ease of removal that's the issue...tearing and serious complications can happen if it's "forced".

Now, what does that mean moving forward? I have no idea. For my own situation, I learned that in cases of permanent leads that occasionally need replacement (I'm hoping not obviously), they generally leave those in too. Scar tissue binds the leads to the heart over time, so it's not so easy to remove. But in cases of infection, it can be done.

I know I was completely unprepared for a pacemaker, and it sounds like there is a lot for everyone to learn about temporary pacer leads too.

 

[mainframe]

I remember after my first sugery, the nurse came by to remove the temporary pacemaker leads. She pulled on them but the didn't come out easily. After a couple of attempts, she left. Awhile later another nurse came in and yanked them with awhole lot more enthusiasim. They ended up coming out.

 

[Luana]

Scott, I wonder why they weren't removed before you left the hospital. I was told I could not be discharged until they were removed and the only person who could remove them was the surgeon. He was busy that day, but finally came in to pull them out. I had no pain at all. I would have pulled those puppies out myself had he not shown up.

 

[Adrienne]

I remember after my first sugery, the nurse came by to remove the temporary pacemaker leads. She pulled on them but the didn't come out easily. After a couple of attempts, she left. Awhile later another nurse came in and yanked them with awhole lot more enthusiasim. They ended up coming out.

Scott, I wonder why they weren't removed before you left the hospital. I was told I could not be discharged until they were removed and the only person who could remove them was the surgeon. He was busy that day, but finally came in to pull them out. I had no pain at all. I would have pulled those puppies out myself had he not shown up.

With me, the first nurse tried to pull them out and couldn't get the second one out. She called another nurse who couldn't get it out either. She said that she would just snip it and leave it in there. I asked if that was dangerous, and she said that it was more dangerous to yank it out if it wouldn't come out pulling the way she did.

 

[ElectLive]

I probably wouldn't have thought twice either if one nurse, two nurses, even three nurses came by to yank mine out with all their might. But not anymore. I probably should have been more direct my first post. Excess bleeding, tamponade, and even death do in fact happen as a result of forcing the leads out. Now, it's rare, so let's not get too spooked here. But that's why they are left in in some cases.

I did track down one article I'd seen: http://icvts.ctsnetjournals.org/cgi/content/full/11/6/854

I had my temporary leads removed during the pacemaker surgery so it was a completely different situation. I'm curious, for those still posting: when they pull the temporary leads out normally, does anyone (nurse, surgeon's assistant, etc) mention any risks or go over special monitoring procedures they follow afterwards?

I guess there just is no fool-proof heart intervention, no matter how supposedly "minor". Everyone talks about the risks of open heart surgery itself, but no one ever mentions removing leads, or the risks of pre-surgery cath, etc.

 

[Jkm7]

At Mass General, PA pulled mine my second surgery. He consulted with me prior to pulling them but knew I'd been through OHS four years prior at MGH so this was not my first experience. He cautioned I would be monitored carefully for one hour after they were pulled and I could not get out of bed for one or maybe it was two hours. Then asked if I needed to use the restroom before he proceeded..... seeing I was still on Lasix.

Thankfully, both OHS, I had no problems with them being pulled.

 

[Dray]

My leads were pulled two days post op and I was definitely on Heparin. The surgeon warned me there was a 1 in 1000 chance (seems that every risk they explained to me carried those odds!) that they may have to re-operate if pulling the leads caused internal bleeding. As a precaution he ordered three hours of bed rest for me once he pulled the leads. No sitting, walking, standing – not even raising the head of the bed up.

Nurses would come in periodically to check my vitals and make sure I wasn’t short of breath or having chest pain.

 

[Chris M]

I needed a portable pacemaker for a couple of days during my hospital stay so my wires didn't get pulled out until day 6. The doctor that ordered this procedure was very insistent that my INR be 3 or less as he had experience of undesirable problems in others when the INR was over 3. I had to wait a day for my INR to fall to a suitable level.

Like others I had strict bedrest for two hours after the procedure with a machine automatically monitoring my blood pressure every 15 minutes and half hourly checks on my wellbeing by the nurses. I had no problems.

 

[scott.eitman]

Thanks to everyone. For some reason, I only get valvereplacement emails for updates spratically. I didn't think anyone was posting.

I attribute the leads being left in not to my surgeon, but to the resident (or whatever he was). I beleive he was ill-informed as to everything you guys have been posting. I am the loser to this.

STATUS: The leads have not been as painful as they were a couple weeks ago. Hopefully that is a good sign.

 

[Sjrlax69]

My wires are still in post op 6months no pain or problem. However, I did notice a sharp pain to the touch where the pacers were during the first two-three weeks post op.

 

[scott.eitman]

My wires are still in post op 6months no pain or problem. However, I did notice a sharp pain to the touch where the pacers were during the first two-three weeks post op.

What a relief to know that there is someone out there who experienced some thing similar to me. At 6 months, I would have said I was good too. They seem to have shifted a couple months ago, but now the pain has gone away, except it is still a little tender.

Scott

 

[scott.eitman]

As a follow up. I met with Dr. Pettersson and his nurse practitioner last week. I had a CT scan first. The scan showed the leads are OK. We are now thinking that the soreness that I feel may be related to scar tissue from the chest tubes.

 

[Adrienne]

Is it true that we people who have a lead or leads left in cannot have an MRI even though we do not have a pacemaker?

 

[scott.eitman]

Is it true that we people who have a lead or leads left in cannot have an MRI even though we do not have a pacemaker?

I was not told that I have any restrictions due to the leads.

 

[Lynlw]

I was not told that I have any restrictions due to the leads.

It MIGHT be a problem or take lots of work to get an MRI approved with pacer leads in ...or it might not be an issue at all. I don' know if it matter how long the leads are etc. but Justin has his old pacer leads in from his "permanant' pacemaker that was removed and has had several Cardiac MRIs with no problems, BUT it MIGHT be a long frustrating process to get them to agree to do the MRI, at least your first time at that center. At least that has been our experience. I think that fact there aren't tons of people with just pacer leads and no pacemaker that need a MRI probably doesn't help.

One of the things I mentioned when we had some problems was if they now maker pacemakers that are MRI compatable, obviously the leads wouldn't be an issue or their wouldn't be a point in spending all that time and money developing MRI compatable pacemakers if the leads would prevent you from having and MRI anyway.

 

[Adrienne]

One of the things I mentioned when we had some problems was if they now maker pacemakers that are MRI compatable, obviously the leads wouldn't be an issue or their wouldn't be a point in spending all that time and money developing MRI compatable pacemakers if the leads would prevent you from having and MRI anyway.

That makes a lot of sense, especially since when a person has a pacemaker changed because the battery is weak, they just connect it to the old leads. Also, at a certain point, even when they need new leads, they don't take the old ones out, they just fit the new ones in the same vein (I know this because when my husband got a pacemaker last year, he learned all about that). Anyway, it's encouraging reading that paragraph, because one never knows when one might need an MRI.

 

[Lynlw]

That makes a lot of sense, especially since when a person has a pacemaker changed because the battery is weak, they just connect it to the old leads. Also, at a certain point, even when they need new leads, they don't take the old ones out, they just fit the new ones in the same vein (I know this because when my husband got a pacemaker last year, he learned all about that). Anyway, it's encouraging reading that paragraph, because one never knows when one might need an MRI.

I agree, Justin has them every year or 2. He's had 4 or 5 with the leads in already with no issues.. well no problems once they were approved by the "MRI safety comittee" anyway and that's just his heart MRIs also had other ones.

 

[ElectLive]

One of the things I mentioned when we had some problems was if they now maker pacemakers that are MRI compatable, obviously the leads wouldn't be an issue or their wouldn't be a point in spending all that time and money developing MRI compatable pacemakers if the leads would prevent you from having and MRI anyway.

MRI approved pacemakers actually include specially engineered leads, or so the manufacturers say anyway. You can't just connect an MRI pacemaker to an old lead, it wouldn't be an approved system. St Jude has a long list of adverse effects on their pacemakers from MRI. For my model, they include:

MRI for patients with implantable devices has been contraindicated by MRI manufacturers. Clinicians should carefully weigh the decisions to use MRI with pacemaker patients.
Additional safety concerns include:
- Magnetic and RF fields produced by MRI may increase pacing rate, inhibit pacing, cause asynchronous.
pacing or result in pacing at random rates.
- MRI may result in changes in capture thresholds due to heating of pacing leads.
- MRI may irreversibly damage the device.

Now, approval is one thing, reality is another. If you go elsewhere on the St Jude site, they say the following:

MRI may impair the normal operation of an implanted pacemaker. A review of literature shows isolated cases in which damage occurred, but this is considered rare.

So, I guess my take on it is this: I don't want to volunteer to test how MRI proof my pacemaker system actually is unless I have to (for instance, I was told a CT scan should be more than sufficient to monitor for future aneurysms) but if I do absolutely need to, it appears that as long as everybody is aware of the situation, it can certainly be done with pretty low risk. Lyn, you've obviously already experienced this, good to hear.

Interestingly, I got a St Jude pacemaker, obviously a big name in heart technology, only a year ago that is not MRI approved. It appears a comparable St Jude MRI model has only been approved in Europe so far. Medtronic does have one available, the first and only approved in the US, back in February.

Sorry to further drift off topic here, Scott. I have read about that lead "heating" issue elsewhere too, don't know how serious, or how rare. Might be worth asking about if you ever need an MRI though...

 

[Lynlw]

MRI approved pacemakers actually include specially engineered leads, or so the manufacturers say anyway. You can't just connect an MRI pacemaker to an old lead, it wouldn't be an approved system. St Jude has a long list of adverse effects on their pacemakers from MRI. For my model, they include:

MRI for patients with implantable devices has been contraindicated by MRI manufacturers. Clinicians should carefully weigh the decisions to use MRI with pacemaker patients.
Additional safety concerns include:
- Magnetic and RF fields produced by MRI may increase pacing rate, inhibit pacing, cause asynchronous.
pacing or result in pacing at random rates.
- MRI may result in changes in capture thresholds due to heating of pacing leads.
- MRI may irreversibly damage the device.

Now, approval is one thing, reality is another. If you go elsewhere on the St Jude site, they say the following:

MRI may impair the normal operation of an implanted pacemaker. A review of literature shows isolated cases in which damage occurred, but this is considered rare.

So, I guess my take on it is this: I don't want to volunteer to test how MRI proof my pacemaker system actually is unless I have to (for instance, I was told a CT scan should be more than sufficient to monitor for future aneurysms) but if I do absolutely need to, it appears that as long as everybody is aware of the situation, it can certainly be done with pretty low risk. Lyn, you've obviously already experienced this, good to hear.

Interestingly, I got a St Jude pacemaker, obviously a big name in heart technology, only a year ago that is not MRI approved. It appears a comparable St Jude MRI model has only been approved in Europe so far. Medtronic does have one available, the first and only approved in the US, back in February.

Sorry to further drift off topic here, Scott. I have read about that lead "heating" issue elsewhere too, don't know how serious, or how rare. Might be worth asking about if you ever need an MRI though...

I wouldn't test a pacemaker in me (or want a family member to) with an MRI, if it wasn't a MRI compatable. It certainly isn't worth the risk to damage the pacemaker or functioning leads either, to me anyway. I think it would be very hard to find anyone will to do a MRI on someone with a pacemaker that isn't "MRI compatable" anyway.

Just to be clear Justin NEVER had an MRI while he had his pacemaker, he has had about 5 with his old leads still in him. Yes heating was one of the concerns, but since he leads weren't being used and when/IF he needs a new pacemaker he'd get new leads anyway, for HIM the benefits outweighed the small risks. Also his leads ar longer than most since his pacermaker was in his abdomen/under his lowest ribs, plus they had to make them extra long so there wouldn't be a problem with growing.

 

[ElectLive]

Thanks for clarifying Lyn, I did misread your post, or think I may have even misplaced patients (Adrienne's husband) undergoing MRI because I was reading too fast. I usually do take my time, sorry! I have actually read about MRI trials they're doing with non MRI compatible pacemakers, using special procedures, that had good outcomes. That was likely in my mind too. Anyway, my point was that in theory, MRIs aren't actually recommended either for abandoned leads or active leads with pacemakers, but both can be done. In either case, it's certainly something to go over in detail beforehand. Hopefully, I won't have to worry about this in the future, although perhaps fairly likely I will. I guess I'll just leave it to the professionals to speak to the risk then.