icd replacement--lead extraction?

[mongo_jones]

hi all,

sorry if this is a foolish or redundant question but i've been reading some of the horror stories here about icd lead extraction and am wondering: this isn't something that you have to get done when your icd is replaced is it? i was told the leads had a much higher lifespan than the device itself and nothing was mentioned about them having to ever be extracted. is extraction only done in case of fractures or problems? and in all other cases do they just implant new leads by the old ones when they wear out?

thanks!

mongo

[sueb]

Re: icd replacement--lead extraction?

Great question. I have not seen any problems with leads mentioned on this site (as I remember) but lots posted on the ZAPPER website. I keep thinking that maybe it's because Lisa keeps prodding us to see specialists and the people on the ZAPPER board seem to be at the mercy of just about any M.D. who wants to try their hand at the game.

I have certainly heard that they can just implant a new lead beside the old one for up to about 5 times. So I have the same question , why are some people having old leads removed? It doesn't sound easy.

Sue

[Sarah]

Re: icd replacement--lead extraction?

Hi,

It is my understanding that when you need a new device, they just swap it out and keep the same leads as before.

Leads need replacing if they fracture or fail. This rarely happens, but obviously it DOES happen. However, if you are being treated by a top center, they are very experienced with this stuff and you are less likely to have problems.

Sarah

[Bruce]

Re: icd replacement--lead extraction?

I'm sorry but suebrowns comment about the people on the Zapper being some what inferior to the people on this board is hogwash. In todays world with insrance companies refusing to pay for out of state surgeries it is very difficult for most people to just hop on a plane to the Cleveland or Mayo Clinic and spend a couple days with the HCMA experts. There are plenty of Heart Centers around the country that have EP specialist that have trained at places like Johns Hopkins, Jefferson in Philly, Baylor ect. and have just as good reputations. Even little old Wilmington Delaware has its own Heart Center and quite a few very good EP specialists.

That said, I'm sure there are just as many MDs who have annointed themselves EP specialist and are the cause of needless pain and suffering to our friends with HCM.

This is not a personal attack. My heart rate went up a few beats while reading this post and just had to respond. Since my ICD is set to deliver thearpy at 150bpm I just had to reply before that happened. That's my two cents. Now I feel better

[Lisa Salberg]

Re: icd replacement--lead extraction?

Bruce, I do not think that Sue intended to be disrespectful of anyone.

Sue, Point well taken on this end.

Mongo (gotta love that name), Leads do need to be replaced from time to time but it is not likley that they need replacement each time the device is changed. I myself have leads that were implanted in 1992 that are still there - one is "capped" off meaning I no longer use it and 2 leads that are active. Someday I may need the lead to be taken out but for now they are fine (11 years + for 2 of them nearly 7 years for 1).

Now a general note - Leads will need to be replaced regardless of who implants them, leads fracture and leads fail - they are man made devices implanted by humans and face it humans make mistakes...therefore no matter how good the center, the doctor or the manufacturer - they may fail...but they are not likely to do so.

Back to Bruce for a minute.. there are gret doctors out there that are not "HCM specialist" you are 100% correct and we are happy to acknowledge that fact. We do feel that most people with HCM get the best care when working in coordination with a specialty center and a local cardiologist (or EP as the case may be).

Thank you all!
Lisa

[Sarah]

Re: icd replacement--lead extraction?

Dear Bruce,

I re-read Sue's post and I don't see where she said what you think she said.

My reading of her post was that people on the Zapper board are not getting advice from an organization like the HCMA --they are at the mercy of whatever doctor they end up with b/c the Zapper site is just information and a forum, it isn't an organization that tracks doctors and centers and so on like the HCMA does.

I don't think she in any way said that Zapper posters are inferior --it was a commentary on the type of site it is.

Sarah

[Wayne]

Re: icd replacement--lead extraction?

Reference lead extraction. I just received my fourth icd replacement. My second replacement required a lead extraction. Maybe it was luck or maybe, more so, it was the expertise of my doctor. My extraction went very well with no complications. In my instance, the doctor used a lasar (sp) beam, which does not in itself involve the more intrusive operation done in the past. Infections at the ICD site and just bad leads, although rare, can make lead extraction possible.

Wayne

[mongo_jones]

Re: icd replacement--lead extraction?

hi wayne,

can i ask why the second replacement required an extraction? was there a problem (infection etc.) that mandated removing the original leads, as opposed to leaving them in there and implanting a fresh set next to them?

thanks!

mongo

[Wayne]

Re: icd replacement--lead extraction?

Hi Mongo_Jones,

My lead extraction resulted from defective leads being implanted on my initial pacemaker. Hospitals or Doctors referred to the defective leads as an "advisory" from the manufacturer when informing the medical community that "Bad" leads are on the market. It is my understanding that the "leads" are not made by the pacemaker manufacturers, but by a seperate manufacturer. At any rate, since I originally had DDD pacing from a national institute of health near Washington, D.C. I had three leads and two of them were not working properly. My Doctor and myself decided to replace all leads as to prevent other lead problems. This is not a common occurance. It must be noted however, that the initial installer of my leads did not notify me of the "advisory." For about six months, my heart felt like someone starting a yamaha while lying down in bed. Again, Lisa and the Doctor she to whom she referred me saved my life.

Wayne

[Ada]

Re: icd replacement--lead extraction?

Mongo,

When I had my ICD replaced two years ago, they found that my lead (I only had one then, I have two now) was fractured. My doctor recommended I have it extracted, but he let me decide what I wanted to do. I chose to have it extracted. I had confidence in the doctor doing the procedure, and everything went fine.

Ada

[mongo_jones]

Re: icd replacement--lead extraction?

don't lead fractures show up when the icd is interrogated? anyway, i leave for my icd interrogation in the next 20 minutes--i'll ask my ep all about all of this and post her responses here.

[Wayne]

Re: icd replacement--lead extraction?

Lead fractures do show up on interrigation, however, the institute that installed my leads put me on an annual visit and only did eco when my annual visit occured. When I complained of fibralations, I was told it was in my head. Needless to say, my level of care was not the best at the "institute."

[mongo_jones]

Re: icd replacement--lead extraction?

hi all,

so i had my second 3 month icd follow-up yesterday and asked my new ep and the medtronic tech all about lead extraction. this is what they had to say:

the tech (who i asked about fractures) said that fractures were more common some years ago but with improvements in lead technology are less so today. this may be some sort of company line but since medtronic doesn't make the leads, and since i already have the thing inside me and am in no danger of changing my mind at the thought of potential problems, i don't think she was blowing smoke at me. she also told me that lead fractures, when they do happen, are almost always caused by structural integrity issues ie. short of placing a tremendous amount of pressure on my chest there's little i myself can do to cause my leads to fracture. she also confirmed that lead fractures are caught in icd interrogation since one of the things they check for is lead integrity.

the ep, who is apparently very experienced with icd/pacemaker implantation, told me that she does not like to extract leads regardless of the cause of failure. she confirmed that extraction is a complicated process and feels that unless there is infection at the original site she sees little need to remove leads. she usually implants new leads right next to the old ones--she said that since leads are getting thinner every year, and since without fractures they should last at least 15 years, she has little worry about running out of room in the vein for people who don't encounter lead problems and thus don't need tons of new leads put in. she verified that when lead extraction absolutely is necessary it should only be done at experienced centers, and that patients should ask for proof of this experience. she said some places say they do it, but don't have the best equipment.

i'm also glad to report that 6 months post-implantation my device is working just fine and has not caught anything untoward in my ticker. hope everybody else is doing well too!

mongo

[Lisa Salberg]

Re: icd replacement--lead extraction?

It sounds like good information from knowledgeable people.

I hope your feeling well!

Lisa