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What Causes Soreness In The Diaphragm Post Pacemaker Placement?
I have had a pacemaker put in about 2 weeks ago. I was told by the Dr who put it in that he put 1 on the wires too close to my phrenic nerve. About 3 or 4 times a day my right diaphragm jumps up and down to the point my muscles are sore from this. The Dr. knows about this and has turned my pacemaker down 3 times and it still happens. Is this common and what can be done to fix it. I have read you never get used to it.. The Dr. says the only thing to do is to repeat the surgery and he said he really does not want to...... Thank You Does this happen often to other ones who get a pacemaker or Malpractice?
Fri, 29 Mar 2019
Hello,
You'll perceive pain and will usually be able to do all the things you want to do after around 4 weeks. The time you need off work will depend on your job.
Your cardiologist will usually be able to advise you about this. Typically, people who have had a pacemaker fitted are advised to take 3 to 7 days off.
If this continues, visit your cardiologist again to rule out extracardiac stimulation. Extracardiac stimulation usually involves the diaphragm or pectoral or intercostal muscles.
Diaphragmatic stimulation may be caused by direct stimulation of the diaphragm (usual stimulation of the left hemidiaphragm) or stimulation of the phrenic nerve (usual stimulation of the right hemidiaphragm).
Diaphragmatic stimulation occurring during the early postimplantation period may be caused by micro-dislodgment of the pacing lead.
This phenomenon is most commonly in patients with LV coronary vein branch lead placement for biventricular stimulation.
During implant, high-output pacing at the maximal voltage and pulse width should be tested routinely to avoid diaphragmatic stimulation.
Stimulation can be minimized or alleviated by decreasing the voltage output or pulse width, or both, but an adequate pacing margin of safety must be maintained after the output parameters are decreased.
If the problem cannot be resolved by reprogramming the pacemaker output, lead repositioning will be required at the moment.
Pectoral stimulation may be due to incorrect orientation of the pacemaker with its active surface in contrast with the muscle or a current leak from a lead insulation failure or exposed connect.
Hope I have answered your query. Let me know if I can assist you further.
Take care
Regards,
Dr AJEET SINGH, General & Family Physician
You'll perceive pain and will usually be able to do all the things you want to do after around 4 weeks. The time you need off work will depend on your job.
Your cardiologist will usually be able to advise you about this. Typically, people who have had a pacemaker fitted are advised to take 3 to 7 days off.
If this continues, visit your cardiologist again to rule out extracardiac stimulation. Extracardiac stimulation usually involves the diaphragm or pectoral or intercostal muscles.
Diaphragmatic stimulation may be caused by direct stimulation of the diaphragm (usual stimulation of the left hemidiaphragm) or stimulation of the phrenic nerve (usual stimulation of the right hemidiaphragm).
Diaphragmatic stimulation occurring during the early postimplantation period may be caused by micro-dislodgment of the pacing lead.
This phenomenon is most commonly in patients with LV coronary vein branch lead placement for biventricular stimulation.
During implant, high-output pacing at the maximal voltage and pulse width should be tested routinely to avoid diaphragmatic stimulation.
Stimulation can be minimized or alleviated by decreasing the voltage output or pulse width, or both, but an adequate pacing margin of safety must be maintained after the output parameters are decreased.
If the problem cannot be resolved by reprogramming the pacemaker output, lead repositioning will be required at the moment.
Pectoral stimulation may be due to incorrect orientation of the pacemaker with its active surface in contrast with the muscle or a current leak from a lead insulation failure or exposed connect.
Hope I have answered your query. Let me know if I can assist you further.
Take care
Regards,
Dr AJEET SINGH, General & Family Physician
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