Pacemaker lead extraction and re-position

  I read a reply that was given to this subject in September, but really did not
  get the information I have been looking for.  I have had three previous pacemakers
  and the one I have now is working fine except the ventricular lead is mis-positioned.
  My doctor has told me of the risk involved in removing the capped leads and
  repositioning the ventricular lead.  I have been experiencing the dizziness and
  light headness.  I appreciate the fact that my doctor is proceding with caution
  and has ordered a hard wire monitoring (month long)and wants to be sure we do not
  do anything un-necessary.  My question is concerning the use of laser and what is the
  technique used.  Is this done through the vien or is there an incision made in the
  chest?  Also, when "infection of pacemaker" is mentioned, what does this actually
  mean?  I guess I am actually wanting to hear other views to this and some of the
  dangers involved.  I do have confidence in the doctor here in Houston and he is
  a second opinion but would like to hear from more sources.  I will be deciding
  next month to which treatment will be given.  By the way, the original diag. was
  an A V Node Block.  The ventricular side of the pacemaker was turned off 1 1/2 year
  ago by orders of another doctor due to the unit not functioning correctly due to
  the lead.  As I have discussed with my doctor, I still have the same symptoms as
  before turning this side off.  The other doctor just did not want to make any changes
  and felt that the atrial side working would be sufficient.  The doctor I am going
  to now is questioning this decision, but is seems that the ultimate choice is
  left to me.   Any comments will be appreciated.
  Thank You,
  Jim

[CCF Cardio MD - MTR]

_

Dear Jim, thank you for your question.  Your case sounds complicated and without all the details, I can't be too specific in my answer, but I'll try my best to give you the information and resources you request.  When pacemaker leads are extracted with a laser system, the laser is mounted on a catheter that is inserted via a central vein either in the groin, neck, or below the collarbone.  The catheter is positioned around the pre-existing lead and a laser is used to sever the scar tissue that attaches the lead tip to the heart muscle.  The laser is contained within the catheter.  An infected pacemaker means that either the pacemaker battery/generator is infected or the lead itself is infected.  When the battery is infected, the infection is usually contained within the pocket created to hold the battery and drainage of the infection, along with antibiotics, usually is curative.  When a lead is infected, however, the situation is worse since the lead has direct contact with the bloodstream so the infection could disseminate throughout the entire body.  Thus, an infected lead usually needs  to be removed and replaced after an appropriate course of antibiotics.  I really can't comment on how your pacemaker is programmed now and how the atrial and ventricular leads are functioning due to lack of information.  However, I will give you the name of one of our cardiologists here at the Cleveland Clinic, Dr. Bruce Wilkoff, who specializes in pacemaker lead extraction. Dr. Wilkoff can be reached at 216-444-4975 and would be a good resource for you.  Good luck!

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.