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Displacement of pace maker - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   hi
Doctor :  
are yu back
User :   yes i am
User :  
but i am unable to see my earlier transcripts
Doctor :  
is she having any symptoms
User :  
anyway, you can go ahead
Doctor :  
like breathlessness
User :  
she is not having any other problems
Doctor :  
chest pain
Doctor :  
ok
User :  
no, none whatsoever, the cardio doc said that currently, her heart has improved and is beating well on its own
Doctor :  
ok
Doctor :  
thats good
Doctor :   is she hypertensive
Doctor :  
or diabetic
User :   yes she is diabetic
User :  
and also hypertensive
User :  
my query is as follows
Doctor :  
is sugars under contro;
Doctor :   please proceed
User :  
whether such cases do happen - displaement of the pacemaker?
User :  
around 150 ppbs
Doctor :   the displacements of pacemakers is a very very rare condition
User :  
whether it is advisable to undergo another ordeal of placing it in its correct place??
User :  
can it happen again??
Doctor :  
happens in 1 5000 surgeries
User :  
what is risk to her health in such operations??
User :  
should we get it done now or wait for the heart to improve on its own??
Doctor :   based on her age , sugar status and BP status
Doctor :  
and already implanted pacemaker
Doctor :  
it will be difficult for her to get one more operation
Doctor :   there may be a chance of 2nd pace maker displacement also
User :  
ok...
Doctor :   usually the pacemakers are not easily displaced
Doctor :  
but in this case the second time displacement can also be there after operation
Doctor :  
and the recovery of the patient after the operative procedure
Doctor :  
is also very importannt
User :  
yes, the doctor says, such displacements are possible in either children or aged people
Doctor :  
its better to wait,
User :   ok...
Doctor :  
so that her heart it self will gain a control
Doctor :  
and start functioning better
User :  
ok.....
Doctor :  
but a good control on sugar and bp is very
Doctor :  
important to keep heart in a good state
Doctor :   regular ECG once in 15- 20 days
Doctor :  
and 2D echo once in 2-3 months
User :  
ok...
Doctor :   will keep a watch on heart
Doctor :  
age is a very important factor
User :  
ok
Doctor :  
even she needs fitness for surgery also
User :  
yeah...she is weak today, she is still recovering from the earlier surgery
Doctor :  
even after surgery the recovery is also very important
Doctor :  
thats right
Doctor :  
as its a major surgery
Doctor :  
it will be very difficult for her
User :  
yes, i did ask the cardio doc if we have to through the same ordeal again??
User :  
he said 'almost the same'
Doctor :  
yes it will be the same procedure
User :   doctor, is it possible that the displacement is on account of medical negligence on the part of the doctor and his team???
Doctor :  
do a surgery and correctly place the displaced one
Doctor :   let me explain this to you
Doctor :  
the common causes are
Doctor :  
a siginificant trauma over the system can cause displacement
Doctor :  
hi are yu there
Doctor :  
hi are yu there
User :  
es
User :  
yes
Doctor :  
ok
User :  
over what system doctor??
Doctor :   on the pacemaker
Doctor :  
there are certain syndromes
Doctor :  
like Reels and twiddlers sydrome
Doctor :  
which are the rare causes of the displacement
Doctor :   The approach to lead displacement is going to be different depending on
Doctor :   1. time from implantation
Doctor :  
2. patient clinical status
Doctor :   3. degree of malfunction of the device
Doctor :   4. how much its displaced, either atrial, ventricular
Doctor :  
when was the pacemaker implantation done
Doctor :  
?
User :  
mid feb 2009
Doctor :  
ok its early displacement
User :   according to the doctor, there is no malfunction of the device
Doctor :  
ok
Doctor :  
In early displacements, reopening the pouch and lead reposition are possible
User :  
we do not know on how much has it displaced and whether it is atrial/ ventricular
Doctor :   In late displacements, surgical repositioning is often not feasible
Doctor :   ok
User :  
ok
Doctor :  
2 factors are in favor
Doctor :  
one is early displacement
Doctor :  
and other is no malfunctioning
User :  
so, if do not do it now and want to do it later at any time, it will be relatively difficult right??
Doctor :  
even other 2 factors are important
Doctor :  
one is clinical state of patient
Doctor :  
and other is either atrial, ventricular
Doctor :  
yes you are absolutley correct
User :  
her age and clincal status are also likely to worsen than improve isnt it??
Doctor :   late displacement a solution is to implant a new lead in the chamber in which displacement has occurred canceling the previous one

User :  
ok
Doctor :   However, prevention and not treatment is the most important aspect when dealing with lead displacements
Doctor :   Several facts have to be taken into account in order to avoid lead displacements:
Doctor :   1. Surgical implantation must be adequate from a technical point of view
Doctor :   these are the few important points on implanted pacemaker
Doctor :  
Is there any thing i can help u with
User :  
thats it doctor, thanks for your advice, we will think over and decide
User :  
whats your name by the way doctor
User :  
are you a cardio too??
Doctor :  
speciality- family medicine
Doctor :  
Please fill the feed back form
Doctor :   please fill the feed back form
Doctor :   hi are yu there
Doctor :  
ok take care
Doctor :  
thanks for consulting health care magic
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