Leads for Cardiac Devices
ฝัง
- เผยแพร่เมื่อ 10 ต.ค. 2018
- A description of different kinds of leads for implanted cardiac devices (PMs, ICDs, and CRTs). I discuss how leads are implanted, what leads are made of, how they attach to the heart wall, and how the body reacts when leads are implanted.
**Warning** I am not a medical professional giving medical advice. I am not employed by any medical device manufacturer, nor do I speak on their behalf. To learn more about your specific make and model of your implanted medical device and/or leads contact the Patient Services group listed on your patient ID card.
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Have posted your Utube page again to educate a panicked lady in Australia. Just watched the leads video. Great content for those afraid of pulling out leads...which is most of us. Plain language and reliable information. My appreciation as usual.
Thank you so much for this patient-friendly demonstration/explanation! I'm three weeks post-implantation today, and your videos are very informative and reassuring. God bless you!
Hi Doug, I had a VERY bad heart attack w/stemi, I just had a Medtronic defibrillator installed exactly like yours w/ the remote monitor, I just want to thank you for doing these videos, they help so much.
As usual, you give us valuable information and I am grateful for each video you share.
Thanks so much for makig all ofnthese videos. I'm getting my ICD in two weeks and this is all super helpful in answering a bunch of my basic questions.
Great info, Doug. Thanks!
Your videos are very helpful! Especially for a biomedical engineering student like me!
I had watched several of your videos; very informative. I need this information since my mom is also a pacemaker patient and she just had a new device this week after the first one.
Another very informative and reassuring video. I’m a visual learner and found this really helpful, thank you so much. I wish the medical staff had explained this to me, I’m sure it would have helped with some of the anxiety post implant.
Once again Doug could I offer my sincere thanks for yet another superb video which is so informative. I for one greatly appreciate what you do. Many thanks again and best wishes from Northern Ireland.
Thank you Billy! I appreciate your kind words, and thanks for watching.
Thank you for this. Very informative.
You're absolutely great 👍👍
I hope you will upload another video that explains or discusses about having the old pacemaker running for another 2 years and implanted another device knowing that she has to keep both devices on.
Thank you, very interesting and useful info.
That's for such valuable information for us pacemaker uses.Brill
I love insertable devices and have a defibrillator/pacemaker combo.
Very informative sir
Some informative - thank you so much
Meant to read so informative😊
My mom is in the Philippines and no one could ever perform to remove the old device. The doctor was saying just to keep it on for her safety.
Hi Doug how do you know if your leads have been dislodged? I have an ICD that was implanted 2 weeks ago and I'm just trying to educate myself. thank you for your videos
Hi Therese, thanks for the note and thanks for watching. There's a couple of different ways you might know if a lead is dislodged. One is if you start experiencing symptoms again. Things like light headedness, or being really tired. Those are signs that a pacing lead has dislodged. With an ICD the other way to know is that your device will emit a tone at a specific time of day if it sees something change drastically, like thresholds. Thresholds would change drastically if a lead dislodged, so your device might emit a tone in that case. Other times (and this is what happened with me) it took an xray to determine that the lead had moved enough that it would be ineffective in its current location. The good news is that lead dislodgements are not terribly common. They do happen, but most patients never experience one. So, its best to follow your doctor's post implant instructions (don't lift anything more than 10 pounds for 6-8 weeks, don't reach above your shoulder for 6-8 weeks, etc) to give your leads time to heal in place. After that you can slowly return to your normal routine. The hard part is not worrying about issues like lead dislodgements. Best of luck on a quick recovery!
Hey Doug, thanks for the videos. Can I ask a question about the leads? I do light, not competition, bodybuilding. I was told that a bench press was no longer allowed in my life as the motion of pushing your hands straight out from your chest can cause the lead to fatigue in one spot where it goes under your collar bone and can cause the lead to break at that mid point. Not pull out of the device or pull away from the scar tissue, but break. From your description of how the lead is actually put into my body, I don't know how that would be possible. Have you ever heard of anyone breaking their lead form repetitive motions such as bench pressing?
Hi Chris, thanks for watching! Yes, I have heard of the issue you’re describing. It’s called clavicle crush and is when the clavicle bone presses down on the lead repeatedly causing the lead to fracture. This is only an issue of the lead was implanted in such a way that it would be in close proximity to the clavicle bone, which does happen from time to time. An X-ray should show where your lead is in relation to your clavicle bone and if you should be concerned. Regardless I’ll share with you what my doctor told me. He said my ICD is there to allow me to live, not to restrict my life. If bench pressing weights is what I want to do, I should do that and if any issues (like clavicle crush) present themselves he will fix the issue. So, I do lift weights. Just dumbbells, but I do bench press with 30lbs in each arm. I’m working on increasing that to 45-50, and while my chest muscles around my device get sore, I don’t feel I’m harming my device or leads. However, if I do somehow damage them, I know my doctor can address the issue, and then I will reassess my decision to lift weights. Until then, I’m loving my life the way I want to. At least, that’s what I’m doing. You’ll have to decide for yourself how much activity you want to include in your life. Best of luck to you!
Thank u for the info. ..so my lead dislodged so...idk how it happened if I was careful
It most likely wasn’t anything you did. Recent research indicates that movement restrictions after implant don’t have a noticeable impact of the number on the number of lead dislodgments. They just happen sometimes.
Thank you so much for the informative video. I have two questions about leads hoping you can shine some light.
1. What is the purpose of the 2nd lead in an ICD? Do single lead ICD pace as well?
2. Does having ICD lead increase risk of coronary artery disease or increased risk of blood clot/stroke/heartattack, since the scar tissue around the lead takes up space? If I already have high cholesterol with plaque am I at more risk with a lead?
3. Will all the leads compatible with future new devices?
Hi there, thanks for watching! I think I can answer a few of your questions:
1) the second lead is there to pace a different chamber of your heart. Typically the first lead is for your right ventricle (but not always), and the second lead, if it's needed at all, is for your right atrium. Some people do just fine with a single lead system, others need the help of a two-lead system.
2) These are good questions, but I don't know the answer to those. Your Cardiologist or EP should be able to answer those for you.
3) The sizes and header block pins of the leads are standardized across the industry. So, a lead implanted today will be useable for decades into the future, even if you get a device from a different company. I hope those answers help!
Very informative. I’m now on my third ICD, but the lead is the original implantation from 2000. I asked my surgeon about that. He said that it’s pretty risky to remove the original lead because a lot of scar tissue develops around it, so there’s a greater chance of having a small tear in the heart muscle that can cause some heavy bleeding. So even though he performs the procedure, he recommends against it. A big problem, however, is that the newer generators are immune to more common magnetic forces - in the kitchen, at the airport - but the original lead is not. So the patient can be lulled into a false sense of security about exposure to magnetism.
Hi Dave, thanks for watching! Lead removal has come a long way in the past decade, but there is a risk. If the old lead isn’t causing any problems it’s safer to just leave it right where it is.
The only real concern with older leads is their restrictions when it comes to MRI machines. Some older leads have been declared “safe” for MRIs, but many haven’t. Otherwise, the leads aren’t affected by magnetic forces like metal detectors or small kitchen appliances. A modern device connected to a 20 year old lead would be safe in those environments.
@@DouglasRachac My electrophysiologist currently thinks that lead removal is to be avoided unless it has deteriorated from, say, excessive body-building. I said, “do I look like like someone who does body-building, excessive or otherwise?!” But, as you pointed out, the old leads may be subject to harmful effects from an MRI. There is an online database of the various models, and mine is listed as unprotected. So I have to be cautious, and I would never buy an induction stove, for example. Why take a chance?
Doug can you tell me about what percentage is mean when you're using your pacemaker for example if you have a yearly check up and they say you have used it 30% what does that mean is it 30% of the year?. I can't imagine if you're not totally p as paced that you would be 30% each day. Thanks for all your info
Liz, sorry for the delay... If they say you're being paced 30% of the time that means that 30% of the time your heart needs a little help. It doesn't mean your heart didn't or wouldn't work. It just means that 30% of the time your heart didn't beat within a particular set amount of time, so the pacemaker did it for you. That is an average amount, so some days during the month your device will work more and some days it will need to work less that that amount. And a higher percentage doesn't necessarily mean your heart is any less healthy. A person with a device that paces 50% isn't worse off than someone whose device only paces 10% of the time. It just means their heart isn't beating in a set amount of time, so the device picks up the beats to ensure optimal functioning.
Fascinating stuff! The leads are larger than I expected. What diameter are the veins that they are inserting the leads into? Thanks.
That’s a good question, John…. One I don’t know the answer to. But, I do know that some people have up to five leads in their veins, so they hold quite a bit. Todays leads are much smaller than the leads of yesteryear, so I’m sure they can fit more than 5 or today’s leads.
@@DouglasRachac Thanks Doug, I did a bit of Googling around this. Fascinating stuff. I won't bore you with the details, but it seems these veins are much larger than they were in my head!!! Take care.
@@DouglasRachac When the cephalic vein in the deltopectoral groove is used, the vessel is highly variable in size. In some it may be only a mm or 2 in diameter. In others it can easily be more than 5 mm. Small veins are easily dilated to accept the electrodes.
Those look BIG to me, like how large is the vein they are going down?? looks like it would blck half the diameter of the vein and more when the tissue forms over it!
thought initially they attach the leads to the outside of the heart surface, I didn't know they actually run it inside a vein partially occluding it, scary!
Hi Hobby, the vein that is used is not a major vein, so restricting blood flow through it is not a concern. Right now leads are a size that allows room for 4-5 leads in the vein at a time, but leads are getting smaller and smaller every year, so they’ll be able to fit more leads inside that same vein. Also, the technology to remove leads has come a long way. Now there is laser extraction technology that makes removing a lead that has been surrounded by scar tissue much easier and safer.
So would you know if you dislodged a lead? I assume they would find it at a check up. I do a lot of heavy lifting.
vwace - There’s a couple of ways you might find out if a lead is dislodged. One way is during an in person check. Another way is through your remote monitoring when your device runs a nightly check and finds something has changed. Often times it’s the patient that discovers it by either feeling sluggish or dizzy (because the pacing of their heart has changed with the dislodged lead) or through a shock received (if you’re an ICD patient). It’s usually a symptom like these that causes the patient to go see their doctor which is when they discover the lead dislodgement. I hope that info helps. Thanks for the question!
Hi Doug,
I worked in an interventional cardiologist's office but have learned so much more DETAILED information from you. Thanks!
Had my 3rd device placed last week with Medtronic Colbalt HF SureScan CRT-D. I went from initial pacer (100% dependent) to combo-unit to the Cobalt as my battery depleted. When my pacer was stepped up to the defibrillator my doc wasn't able to remove a lead so I have an extra unused lead. My question is......since I have the extra lead would that change the protocol for an MRI? I have scoliosis and spinal stenosis and am fused L1-S1 (hardware removed) with more fusions likely and my ortho is considering an MRI. Any thoughts?
If I can ask another question.......when a lead is retained is it clipped off, stitched in place, or what? Thanks again.
Hi Idy Gal, thanks for watching and for your nice comments! I’m glad to hear my videos have been helpful. The MRI question comes down to the individual components of the entire system. Each item, including the unused lead, needs to be MRI compliant or MRI ”safe” in order to have an MRI. There are some larger institutions who perform MRIs on older, non-MRI safe leads, but that’s because they have years of experience with their processes and procedures. You’d have to do more research to find out which ones do this. Unfortunately I don’t know the names of those hospitals.
As for the abandoned/retained lead, they usually “cap” it with a little cover and leave it in the body. Sometimes, if they know it won’t be needed again, they cut it shorter and then cap it. It won’t float around or go anywhere due to the scar tissue it already has inside the blood vessel, so there’s no need to tie it or tack it down further. I hope that answers your questions. Thanks again for the note.
Thanks Doug. Stay well.
Hi, my husband has a Medtronic SureScan, implanted by a super awesome doc in May 2023. Now that it's "healed" I can feel something like a lump up near the top left corner of the conector case / battery pack. He seems to be pacing just fine, and the "lump" doesn't hurt. I was super nervous that maybe he pulled a lead from the connector case, but after watching your video I'm wondering if it's just the suturing sleeve! he's also a very tall & thin guy so there's not any fat hiding the device, lol. Does it being a suturing sleeve seem plausible?
Hi KC, thanks for watching! It could be a suturing sleeve. It might also be the lead itself. There’s almost always enough extra lead to loop it once or twice behind the device, and sometimes one of those loops ends up on top of the device instead of behind. It’s not harmful or dangerous in any way, but you or your husband may be able to feel it. If it doesn’t hurt just keep an eye on it and ask at the next in-office visit. My bet is it’s one of those two things.
@@DouglasRachac Thank you for the reply! He's getting it looked at today just to be safe. :)
Hello, My uncle had kept his ICD since 2013, and when we heard the ambulance siren tone recently, we went to the doctor, who said it was due to a manufacturing defect in the leads, and we needed to replace the lead, but he never received any shock. I was just curious as to why it lasted less than ten years.
Hi Monica, thanks for watching. An ICD from 2013 lasting ten years is actually quite good. Their typical lifespan back then was 5-8 years. Leads are supposed to last a bit longer, but issues like this do arise from time to time. Once replaced the new lead should last a lot longer. Some have survived 30+ years. And todays ICDs are designed to last 8-12 years, possibly longer.
It's 2016, not 2013. Thank you for your response.
Also, does one lead work in case of any issues because the other one is a defect, as the doctor suggested replacing it after a month and we planned to do it in 10 days?
What will be the new lead's life span be once changed?
Hi Douglas Rachac!
I have had a pacemaker implanted since 2018
I want to implement "Lucy Wyndham-Read" arm workout and "push up" and "resistance training programs" to lose weight
But I am terrified of moving my hand up or back in sequential motions
Is it safe for pacemaker wires?
I remember being instructed by the nurse not to raise my hand up or sequentially move the hands at the beginning of the pacemaker implantation
But I don't know if I can do that after 4 years of the operation?
I am worried :(
Hello, and thanks for watching! Most physicians will tell their patients that 6-8 weeks after their implant the person can return to their normal activities, whatever that might be. It may be best to check with your physician first, just to be sure.
@@DouglasRachac Thank you!
How long does a lead take to embed into the blood vessels and heart?
Hi Abu, it takes about 4-6 weeks to develop a strong connection between the lead and the blood vessels and heart wall.
If you know, what has been the longevity of Medtronic leads? It's always been a concern of mine that since I'm only pacing @ 2% and have roughly 11yrs left on my battery that when it's time to replace my PM they will need to replace the leads. Do they leave the old lead in place or attempt to remove it? Does leaving it impact blood flow back to the heart? Can attempting to remove the old lead run the potential of damaging the heart wall? (I know, lots of questions for "some guy on the internet.")
Hi Shannon, thanks for watching. Let me see if I can answer some of your questions. Typically, during a procedure to replace the device, they use the existing leads as long as they are still working normally. Some leads last 25 years or more, so there's a good chance one set of leads will be used for at least 2 devices, maybe more. If they do decide to replace a lead they usually leave the old one in place and "cap" it. Adding more leads into the vein doesn't really effect blood blood flow to the heart because the vein they use is fairly minor. Some people have seen a slight rise in blood pressure, but that's not very common. And, the leads are getting smaller and smaller every year, so more leads can fit in the same vein. If they do need to remove a lead the technology to remove leads has advanced in leaps and bounds in the past decade. Lead removal is a common procedure these days and there are doctors who remove/replace hundreds of leads safely each year. I'm sure by the time you need a lead replacement it will be even easier. I hope that helps!
@@DouglasRachac All of that is correct but there is no relation between multiple leads on the right side of the heart and BP.
if we exercise like playing football without being hit Is there a chance that the string will come off from being attached to the heart chamber? And can we play sports like this?
There is always the risk of getting hit in your chest, and that risk is higher when you are playing sports. But the risk of dislodging a lead (pulling it out of the heart) is pretty small. There are products you can buy that will help protect your device, like one called Vital Beat. These kinds of products will help protect your device with a small shield that will reduce the risks of any device or lead related problems.
Question if they sew the leads in place by the vein and a patient were to lose a significant amount of weight I mean would the actual location move? I mean it feels like that piece they sew is actually in the bend of my shoulder and am being told that's what it is and that it is ok. I feel it is not ok.
Hi Regina, thanks for watching. It’s possible that things can move around with a significant amount of weight loss. Most time, though, that won’t affect the leads. It’s more of an issue with devices that are just placed into the pocket, but not secured down. If your healthcare team is confident in the current location of your implanted system I’d say you’ll have to try and trust their opinion. Congratulations on the weight loss! That’s really terrific!
If it is of some comfort to you, I implanted a system in a pt. who weighed over 400 lbs. She subsequently lost half of that and experienced no pacer-related problems at all.
How does stretching and yoga effect the leads?
Stretching and yoga shouldn't be a problem after the 6-8 week healing period. By that point the leads will be securely attached to the heart wall. As always, though, it's a good idea to talk to your doctor first before returning or starting any physical routines. Best of luck!
@@DouglasRachac thanks! You vids are an inspiration to us all.
Can the leads inside the heart, after they develop scar tissue, impede blood flow?
Hi Linda, thanks for watching. I honestly don't know the answer to that. I would assume a little bit, but only for that particular blood vessel. If it was harmful to a person they would have figured out a different way to implant the leads by now. This would be a great question to ask your physician during your next visit.
Hi.I was wondering the same thing. I have had an icd for fifteen years now and have been having a problem with a corroded lead for the last couple of years. The last alarm I had was one month ago and went to technicians who reprogrammed for the third time. Specialist says it’s a dangerous surgery with high risk of infection. I am 64 and not sure what’s going to happen. Thanks for your videos.
@@gailprier3785 hi Gail my mother just had an implant last week .she is 55. Can you tell me about your experience with implant .
@@samisthahayaran2541 hi. I think Dougs videos give honest accurate info on implantable devices. I have learnt a lot and have the courage to question my doctors or technicians on what is important to me. I was 48 when I got my icd. At the time they weren’t that common in NZ and there were no support groups or forums. I think your mum will feel a lot happier knowing she has this back up. I am now 64 and unfortunately after 16 years there has been lead damage. Three weeks ago I made the decision to de activate my icd and take my chances. Lol the battery is still going till it runs out…..the race is on. All jokes aside if your mum listens and questions everything that is being done she will be fine. 🌻
I know the leads going thru the valve causes a slight leak as the valve can't completely close with it there, but it's minimal and I think the valve molds around the lead to close better as I did initially have some leakage and then it went away over time
Does the patient always need to take a blood thinner because of the leads?
Hi Kevin, no, blood thinners aren’t needed because of the leads. There may be other reasons, like persistent atrial fibrillation, that require blood thinners. But usually blood thinners aren’t needed with the implant of one or more leads.
@@DouglasRachac Thank you
I’ve had three ICDs over the last 22 years. I’ve taken blood thinners, but never because of the ICD lead. I take a baby aspirin daily. I occasionally take xarelto if I’m on a long flight, or for a few weeks after an afib episode.
Hello. I am wondering if you've ever been shocked inappropriately due to lead fracture? I have once due to the recalled fidelis lead, five years after implant. I gotta say I think I have PTSD from it. The comments on an ICD group on facebook makes me think this is not uncommon. It was actually pretty terrifying getting shocked ten times in minutes a not being able to do anything about it. I do carry a large doughnut magnet with me, unless I happen to leave it at home. Anyway in general I have anxiety because of it.
desotopete Hi, thanks for leaving a comment. I, personally, have not been shocked either appropriately or inappropriately, so I don’t have that experience. None-the-less, I have been diagnosed with PTSD and general anxiety. The research I have seen shows this is very common among cardiac patients with as much as 50% of patients experiencing symptoms. If anyone suspects they might be experiencing PTSD, anxiety or depression I highly recommend seeking professions help. Speaking with a therapist worked wonders for me.
@Atit Sorry this happened to your daughter. Although my lead had been in for 5 years, I discussed it with my Dr. Naturally I asked if she would take it out. She said she would try but my impression was that she was doubtful she could do it. To my surprise after the operation, and ICD replacement at the same time, she said the old lead came out "like butter" My impression is that she was surprised it was able to come out. I think there are clinics that specialize in lead extraction, pretty sure where I go does not specialize in this. Maybe I was just lucky. At a young age having a lead left in would be a concern although I do understand this is somewhat common.
@Atit Lol. Around here we call "my girl" as "my old lady"...
@Atit Southern Illinois. You?
Very informative video...however as a hip and leg amputee...the body most certainly can and does destroy foreign bodies.
Please, Can I go to sauna with my peacemaker?
Hi Samuel, the leads and device can certainly handle a sauna, but your heart condition may not allow it. You need to speak with your doctor to ask if your heart can handle the higher heat of a sauna. If so, your device and leads will be perfectly safe, protected by your body.
@@DouglasRachac Thank you for your answer. My heart IS ok. But doctor told to me ,than temperature above 40 degres IS dangerous for a device....overheating.....???. Metal parts...?? I have medtronic peacemaker.
Samuel, Your device can handle the temperature of a sauna or hot tub. You can see what Medtronic says on their AskTheICD website (the answers are the same for pacemakers) here: asktheicd.com/tile/420/english-life-with-an-icd/can-i-go-in-a-sauna/ You can also see a sauna is listed in the "No Known Risk" category of Medtronic's Electromagnetic Compatibility Guide here: www.medtronic.com/us-en/patients/electromagnetic-guide/household-hobby.html Your pacemaker can handle a sauna. The only limiting factor would be your specific heart condition. If your doctor clears you to use a sauna with your heart condition, then your device will be right there for you if you need it.
@@DouglasRachac Thank you very very much Douglas. 👍