pacemaker repositioning

[dyn10]

In Feb.2008 I had a battery change. Since that date, there is a lead outline visible in the skin, the PM is floating toward my underarm when I sleep on that side. I am uncomfortable but the functionality of the PM is working.
My issue is that I have been given the option of having a smaller PM inserted, repositioning of pocket and the leads tucked under the PM.
SInce I thought I was through all this in February's changeout, I am having a difficult time making a decision. I have a wonderful EP Dr. and Cardiologist. It is that I cannot make my decision as I would have to go through the procedure all over again, plus the extra surgical work  and recovery.
Any suggestions?
Can the PM move more with the elasticity of skin over time? Will the visible lead protrude more?
The current PM will last 7-10 yrs. If a smaller one is placed in me it will last 5 yrs.
I am trying to weigh the pros and cons.

[Douglas Bogart, MD]

The pacemaker can be better secured in the pocket which would limit the mobility.  In general unless you are very slender there is a very small chance of lead extrusion.  The more times you have the pacemaker pocket opened there is some increase in the incidence of infection.  You need to decide how much this is bothering you.

[dyn10]

Thank you for your response. I am worried that if I don't have the procedure redone that the current lead will continue to migrate. Can that happen? I feel about 2" of it.
The current surgeon would make the pocket elsewhere and secure all. However, he would take out the newly installed one which was larger and put in a smaller PM.
What do you think? I also suffer from panic attacks to which I address with medication and this non decision is not helping me
Thank you