Atrial Lead Perforation - Additional Questions

[jdpalmer]

Thank you for taking the time to respond to my first question regarding my mom.  As a quick recap - 86 year old woman four weeks back had a pace setter dual chamber pacemaker implanted due to her heart rate dropping below 40 beats, with no other heart deviations.  The atrial lead perforated through the atrium wall and into the lung pluera, causing internal bleeding (hospital removed 275cc's of bloody fluid).  The surgeon clipped the lead and now the pacemaker has been programmed to function as a single lead.  

1).  Please help me and my family to understand the possible causes of this situation.

2).  Should the lead be removed or left in and what are the risks of both?

3).  Should a second atrial lead be placed or can the pacemaker function adequately as a single lead?

4).  The pacemaker is set currently at 75 heart beats (it was formerly 60).  The unit is now firing with each heart beat and does not allow the heart to drop below 75.  Is this a normal setting or should the heart rate be lowered?

Thank you

JDPalmer & Family

[DAQ]

Hi,

Sorry to hear about your Mom.  The atruim is very thinned walled. It is not an uncommon thing to happen.  My first pacer lead in the ventricle was placed almost all the way through my ventricle and I had pacing of the diaphragm then it was replaced and then I had chest wall stimulation.  The second pacer lead change resulted in the atrial lead pulling out and just hanging in the atruim.  I have had many pacers leads due to an abnormality of my heart.  I have had 3 pacers in less then 3 years too.  

At your Mother's age it seems a very high rate to be paced at?  I am young and I have 70BPM day time and 60BPM night time.  I run a pacer support group and do work with pacer patients and am doing a study and writing a book.  I have a site that may help you as well as finding another doctor for your Mom if you want another opinion.  I would CERTAINLY ask about lowering that rate.  All to often a patient at that age having a high heart rate can be uneasy for them.  

You can contact me at : ***@**** if you have any more questions.

[CCF-M.D.-CRC]

Dear JD,
I am sure this has been a difficult time for your family and mother and I'm not surprised that you have many questions.  The best source of answers however should be her doctors. These are complex questions and we can only provide general educational information on this site. As with any medical decision the benefits and risks of each of the possible situations must be weighed in light of the big picture.  Only her doctors can help you sort through the difficult choices that now need to be made.

[pazifij]

I hope all goes well for your mother.  I know nothing about your other questions, but my pacemaker is set to keep my bpm at 75.  It was originally set for 50, but I felt awful that low.

[Lyn2]

Hi
I also have a dual chamber pacemaker, and mine is set for 80 bpm.  My understanding is that sometimes the rate is set a little on the high side because atrial fibrillation often starts at a lower heart rate.  So if it is set higher there is less liklihood of atrial fib.  I sure hope your Mom is feeling better.  It does sound like her doctors are doing the right thing.  Sometimes it is hard to know because the doctors don't explain every little thing.  I have found a great deal of information on the net, and feel far less confused.