PACER LEAD CARE Heart Smarts column, Jan-Feb 2013 When we think of care of our pacemakers, not a lot of thought is given to the implanted leads. Remember the six week limitations on raising your arm or lifting? That has more to do with healing of the implanted leads than the pacer site. The magnets, welding, small engine restrictions all have to do with the pacer itself, but the leads can be much harder to deal with than the device. The medical device card you carry has the serial number of both the implanted device and a serial number for each implanted lead. Devices range from having a single lead to three leads for pacing and another for defibrillation. When your pacer gets checked, one of the functions they check is the conductivity of each lead. Over time, the leads can crack or wear thin. While the average life of a pace-maker is 7-15 years, leads usually last longer than that. While 85% of pacers are implanted in people 65 years and older, the increasing longevity of patients makes us have to take a closer look at replacements of both the devices and the leads. Pacemaker lead fractures happen in 4% of cases. It can happen for a number of reasons including lead migration or trauma. When a lead fractures or wears out, it is just left in place and a new lead is attached to the pacer. The most common cause to need a lead extracted is an infection. An infection is at highest risk when the pacer is implanted or changed out, but the risk is always present. A fever with no determined origin in a pacer patient may be a later infection of the leads themselves. Infection rates range from 0.5% to 5% depending on the study and extent of the problem. All the infections need to be treated with antibiotics, but occasionally the pacer and all leads must be replaced to prevent a systemic infection. Extraction of the leads is a much more complicated procedure than the initial implantation. Removal is potentially a high-risk procedure, especially depending on how long the leads have been in place, meaning how firmly they are imbedded in the myocardial wall. Leads are usually extracted with lasers around the wire. As more leads are having to be replaced, more tools and techniques are being made to do such a procedure. Cautery, lasers, and physical forces are employed, but the procedure has risks that may lead to needing to open the heart. Where a device implantation usually to 45 minutes to an hour, extractions usually range from 2-6 hours. Many of us are among the much younger pacer recipients and thus will more likely have to eventually undergo pacer lead replacements. (On the plus side, females have statistically lower infection rates.) We can hope that they will get easier and safer as time goes by, but expect that we will be there to support each other when those times do come up.
Posted on: Sat, 16 Nov 2013 21:54:04 +0000
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