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Pacemaker removal
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Pacemaker removal

I was wondering what percentage of people can actually have their pacemaker removed if it is determined that the patient no longer needs it.  Can a pacemaker ever be removed?  
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187666_tn?1331176945
I don't know the percentage.  I can see the unit itself being removed since that's how they "change the battery." But the leads into the heart, once they've grown over with heart tissue, I don't see how they could be removed.
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Avatar_f_tn
If a person doesn't need the pacer any more, they don't remove the leads without a very good reason as it is a much bigger surgery than putting them in in the first place.  I have seen xrays of transplants... and wires were just cut and the unneeded pacer left in place.  Cracked wires sometimes have to be replaced but it is a major event.  If there is an infected pacemaker pocket, the wires sometimes have to be changed to prevent infecting the heart.  When a pacer goes in, it isn't with the intention of removing it.
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267401_tn?1251856096
That's odd - I thought I'd read of at least one member here having a ICD implanted because of arrhythmias, and after four ablations his heart was doing well, so they removed it.  Unless  a pacer and an ICD are different animals, but I thought they were more or less the same, just with some different programming and slightly differing abilities.
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Avatar_m_tn
Pacers (pacemakers in the vernacular) and ICDs are, indeed two completely different devices with totally different functions.  While both have a battery and a microcomputer these days, that is where the similarity ends.

An ICD is an Implanted Cardiac Defibrillator.  It is used when a person has a tendency to go into or approach V-fib.  The device monitors the heart rate and waveforms and when those match pre-programmed parameters it delivers a significant jolt of electricity to do the same thing as cardioversion.  Since the electricity is being applied directly to the heart muscle it takes much less energy - on the order of joules versus hundreds of joules (1 joule = 1 watt second) in an external cardioversion.

But even that is many times the amount of electrical energy a pacemaker (properly a pulse generator) delivers.  My device is currently running at 1.125 volts and is delivering a few microjoules per pulse.  It takes a lot less energy to trigger a beat than it does to stop the heart so it can reset itself.  If the person you mentioned was in a-fib and the bombardment of the AV node was causing it to go into v-tach and even fib, an ICD would be need to keep the patient alive.  If ablation (or even multiple ablations) reduced the instability in the atria then the AV would be expected to "settle down".  With the threat of v-fib removed an ICD would no longer be needed.

That being said, I do not think my EP would reove the thing.  For one thing the instability could return.  For another, no sense cutting someone open unnecessarily.  

Hope that explanation helped.

Tracie4444, even if the device would no longer be needed there would be no good reason to remove it.  If it is like mine it can be shut down from outside.  There is much more risk of problems cutting someone open - even in so minor a way as would be needed to remove the device - than just leving the thing in place and quiescent.  
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Avatar_f_tn
All pacemakers and AICDs are programmable through the chest wall with devices.  If you have an AICD though, it can be turned OFF with a magnet so be careful.  Then it can only be turned back ON with the programmer.
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267401_tn?1251856096
Thanks BLM, that addresses a bit of the question, but it seems like the crux of some of the first responses is that the leads going into to the heart are the limiting factor in removal of a device, pacer or otherwise.  The person I was referring to said he was having 30,000 or so PVC's a day and getting defibrillation jolts frequently, and after ablations had the device removed.  I would imagine the leads were removed as well.

My question has less to do with the function of each device and more with whether having one device or the other would make future removal more or less difficult.  As I understand it, an ICD and a pacer (and for that matter, the ones that are dual purpose) both are small units with leads that go into the heart.  Unless there was something radically different about the implantation of an ICD versus a pacer, it would seem that if one could be removed, either could be removed, and since there's a member here that had an ICD removed, I would think a pacer could be, too (provided of course that the cardiologist agreed).
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88793_tn?1290230777
Isn't the doctor written down PPM (permanent pacemaker)?  What is the different with just pacemaker and permanent pacemaker then?  

I think now a day some types of pacemaker also can pace out the abnormal rhythm before it reaches to the ventricle.  Like my A-Fib and A-Tachy, it will reach directly to my ventricle without passing a traffic light.  
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Avatar_m_tn
You're welcome.  The device itself is simple to remove.  It sits in a pocket just under the skin below the collarbone.  Absent a terribly compelling reason I would never want to contemplate removing the lead(s).  The lead is threaded down through the vena cava and into the heart.  Over time the heart muscle actually grows around the lead so simply pulling it out (like yanking an electrical cord out of a wall socket by pulling on the cord itself) is not an option.  My understanding is that removing the lead involves open heart surgery.  

But why would someone WANT to remove the device?  If it is no longer needed the simple thing would be to just shut it down and go about one's business.  Our skin serves a very important function as the first line of defense against microbes.  Since removing the device wold involve cutting through all the layers of skin and even the capsule of scar tissue that formed around it, such a procedure would open the patient up (literally) to the possiblity of infection.  Unless the thing is causing problems where it is, the safest course would be just to leave it alone.  

Did I answer your question?

Bionic Bill
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Avatar_n_tn
The reason why I raised the question is because my electrophysiologist determined I no longer needed my pacemaker and removed it in January 2009.  I started having significant episodes right after it's removal and just had it put back in March 6.  I am 39 years old and run marathons and am healthy otherwise.  I am just trying to figure out if this is common or not.  
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1835862_tn?1318376661
I am 64, pacemaker put in 3 weeks ago. Am tired of it and want it out. The  pain, the hideous bulge, the scar are just a few of my reasons. I didnt mind the  dizziness, or feeling faint. This wasnt my idea and want it out! I dont feel any different than I did before and  dont believe it is doing anything helpful. Dont say  to talk to my doctor, I dont like him. He talks  to me like I am a little kid. Is MY body  not anyone elses.
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1807132_tn?1318747197
I am sorry to hear about your frustrations.  I don't really know what to say about your pacemaker since I don't have much experience with them but have you thought about finding a new cardiologist?  You do not deserve to be talked to like a child.  There are a lot of nice ones out there I hope you find one that suits your needs.  I hope things get better for you.
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967168_tn?1343732745
sounds like it's time for a new doctor if you can find one that suits you; I've found most doctor's are like this especially the higher educated ones for some reason - just my opinion of the 17 cardiologists and EP's I've been through in 2 years but others may be able to give you a referral to another doctor

I know about dizziness and fainting and sympathize with you on that...I've hit my head so many times they think when I fainted this past June hitting the tiled side of my tub was 1 more time than it should have been

my CT shows some changes that are consistent with mild brain damage along with my neurological changes that has happened with too many falls; luckily for me I only severely sprained my neck and didn't break it completely so a brace for a few months helped it heal.

I know what you mean about no choice...I had an abltion and I had a DNR (do not resucisitate) order.  During the procedure I felt my heart burst; my heart stopped, I yelled STOP! and tried to sit up to make them stop but they wouldn't.

FL law says no matter what DNR I have; I signed a paper for the dr right as I went into the OR that said he HAD to save me if anything happened

I didn't read the fine print but obviously I'm here for some reason  - For me, I think my device is the lesser of the two evils...
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Avatar_f_tn
I have a relating question to ask! Please help us to find an answer! My husband had a pacemaker implanted on the 15th of December 2011 (6 weeks ago). The doctors made a mistake and implanted the wrong type! Now they tell us that they want to replace it. How dangerous is it? We are so afraid of it! The leads probably have already grown into his heart tissue...
please e-mail the comments to ***@****!
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Avatar_m_tn
I had a pacemaker implant October 4 2010. I am 54 years old now and it seems it really is not helping much anyways. My heart rate seems to still be all over the place . And I really felt the hospital and doctors did not give me any choice about getting the implant in the first place. It is uncomfortable to sleep with and the bulge and the scar really irritate me.After hearing the stories on here about having it taken out really does not sound any more appealing to me than keeping it in.
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Avatar_m_tn
I has a pacemaker put in 4 years ago, I was in the hospital with severe dehydration and Dr cmes and says your heat rate is between 25-35BPM my response was so, he said it was dnagerous I replied well I don't feel bad, never had chest pains, light headness, fainting or even blood pressure issues. Over the next two days as my fluids were replaced and I was more active the Dr came back and said the ame thing telling me if I do not get a pacemaker he will release against medical advice. In todays insurance world I would havehad to pay my entire bill as the insurance company told me if I do not follow Dr's orders they do not pay. So I agreed and have regretted ever since. My left shoulder hurts all the time, I can't sleep or lay on left side, pacemaker sticks out and is very noticeable, and the worst was trying to get thru TSA without taking my shirt off even with all the correct documentation for a implanted pacemeker. Tomorrow I go to Dr and am telling to remove pacemaker not just turn it off, also found that I have been charged $80 a month for ST Judes Merlin monitor that sends data from pacemaker to Dr once every 4 weeks, what a rip-off.
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Avatar_m_tn
Batteries are not changed, pacemakers are sealed units, the whole old pacemaker is removed and replaced with a new one
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Avatar_f_tn
Pacemakers can be removed as I'm having one removed myself
Hope this helped :)
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257552_tn?1404606154
On the topic, they now have leadless Fully Retrievable Pacemakers. The entire device is implanted in the heart, apparently at this time approved for Bradycardia.

http://www.mountsinai.org/about-us/newsroom/press-releases/first-leadless-pacemaker-in-united-states-implanted-into-a-patient-at-the-mount-sinai-hospital
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Avatar_n_tn
In jan 2008 I had my ICD removed.  The Cleveland Clinic has a Doctor (Wilkoff I think is the name) that specializes in removal of PM/ICDs.  At that time Highmark covered everything.  The ICD was pulsing my phrenic nerve.  The local doctors told me it was in my head and not in my chest.  At Clev Clinic they said the problem was the ICD device.  My suggestion to you is to go to another doctor outside of the area where you are.
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