Posted By Jan on July 07, 1999 at 11:32:48
I have a friend who has a dual chamber, epicardial implant. They have 2 leads going up to the right shoulder, and then 2 connector leads from the right to the left across their chest. They had open chest surgery and has metal clips in the breast bone. At times they get a sharp pain in the area of the top of the breast bone. When this implant was done you could see the leads sort of stick up when they layed on their side. Now this does not happen. The patient had asked the EP doctor if this could cause any trouble, and be the cause of the pain if the lead was catching on the clip? This was before knowing the position of the lead for sure. The doctor said no, because the lead is insulated. Which is correct.
But, just recently they had a chest film done, and the radiologist said it was curious that the a-lead goes right through the top metal clip. That there is a chance that this position of the a-lead, may cause constant rubbing against the metal clip and in time, if not already, cause a break in the insulation of the lead. The impedance on the lead is high, but it still senses ok. I would think that the impedance would be low if there was a break? Any ideas? Thank you for any information you may have on this.
Posted By CCF CARDIO MD - CRC on July 08, 1999 at 11:04:40
It may have just been the angle of the Xray that made it appear it was going through the clip. I kind of doubt it is actually going through it. Leads can fracture and if there is a stress point at the clip it may be more likely to happen there. The impedence (resistance) is lower when everything is working well (think of an open pipe).
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Posted By Jan on July 08, 1999 at 16:00:10
Thank you for the info.
It is my understanding then, that if the lead impedance is high, but the sensing is ok, that there still could be some type of lead insulation fracture? The patient does have a fast, only ms. long, pain in the area just where the lead intersects the clip. They are not pacer dependant, and they only feel this now and then, which makes them think this is from pacing. They also have muscle stimulation at the device site, as well as myopotential interference with any movement of the implant side arm. I know this is a rea stumper, but any more ideas?
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