Pacer rejection without infection?

[maccamarsh]

Hello, I've been looking through the forum for information regarding pacer rejection but the cause always seems to be due to infection. I'm wondering if it's possible to reject a pacer for no apparent reason, i.e with no signs of infection?

I'm a 33 year old female and my pacer was implanted in my left side a little over 6 months ago after I was diagnosed with sino-atrial disease (extreme bradycardia). The implant itself was fairly traumatic, with one of the wires being misplaced and I had to go back to the cath lab the following day and have the wire replaced. The wound took a little while to heal, and at the time there were some slight signs of mild inflammation, which I did eventually get a follow-up course of antibiotics for. But it was nothing serious really, I wasn't unwell, didn't have a raised temperature or significant swelling, it just took a little longer to heal and was itchy for a while.  Part of the "internal" stitching broke the surface and had to be tweezed out - after which it seemed to heal a bit better.

However I first noticed, perhaps about four months ago, that one corner of the unit seemed very close under my skin, and not as deep as the remainder of the unit. Whether this was always the case and just became apparent after the wound had healed properly I'm not sure. Gradually the whole outer side (the edge towards my armpit) has come up to the surface and the shape is now very defined under my skin. I can even feel the contours of the unit itself. The skin appears bruised, but it's hard to tell how much of that is shadow caused by the "bulge". It's uncomfortable when I sleep on either side, painful to the touch in places, and I even virtually hooked my thumb under it by accident when I was removing my bra the other night, which was extremely painful. Increased physical activity is giving me some pain, and I get the occasional shooting pain and burning sensation. Running is definitely out - I feel like I have to hold it in place! I have no signs of infection.

So there has definitely been a marked "rising" of the unit just at one end, more pronounced within the past fortnight. It's almost as if the "pocket" has broken open.  Is this possible?  Can the pacer just work its way to the surface? Very grateful for any insight and advice. Many thanks for your time.

[jean5556]

I'm glad to hear someone else is experiencing this also.  I can now see the outline of the wires leading into my heart.  Sometimes it feels  like my pacemaker is cutting me under the skin.  My husband says it's normal and I should learn to live with it.  I'm a nurse and "I don';t think so".  Now I found that if I sleep with my left arm over my head it doesn't hurt as bad.  I once had ear surgery and the tubes kept rejecting and coming out of my ear.  I hope this isn't a repeat of that.

[maccamarsh]

Thanks Irene, I really appreciate you taking the time to comment. :o)

[ireneo]

Yes, I've heard of pacers moving like that. I'm not sure why. Perhaps in some cases it just wasn't put in quite right or a patient may have fiddled with it, constantly touching and pushing it. A doctor may want to redo it (not the leads, just the unit) and place it under muscle rather than just skin. In any case, I think you should show your doctor and see if they want to reinsert it. It sounds like it's slipped out of place.