Here's a video with some general info on first placement. You'll note the placement of the lead thru the tricuspit valve. They don't show what the end of the leads look like! Does Sheet metal screw sound familiar?? It's covered until it's in position then with a twist it exposes. However your newer leads are coated and will not bind to the vein surface. If he's having all these problems with it, this is the way to go. Their more then likely also going to replace the pacer which should be a blessing. I personally like the newer St. Judes there like mini lap-tops in your chest. It's unreal the amount of info you can get from them and the transfer system has to make contact with the body to get your info so there pretty secure also.
As far as removing the old leads it's kind of a pain in the B--T but can be done ok if the screw cover returns to it's covered position. If not, it's time consuming. The electrophysioligist's are usually pretty good at this. Providing he's not totally dependent on the pacer. That's another story!!!
He might have to spend the night after the procedure but he'll be better off in the long run. Wish him luck!!

http://heart.emedtv.com/pacemaker-place ... video.html

This depends if it's in the ventricle or the atrium. In the ventricle the old lead should be removed because of the passage thru the valve, eventually your going to stress the leafs. If it's the atrium go for the, "add a lead" option. "Having a team to help," means having a surgical team on standby and scrubed. As you can imagine putting a screw into muscle and leaving it there and the tissue grows to it. Then trying to twist it out could cause some major damage if one is not real careful. The image on the screen is sometimes not all that great. Like I said this all takes time and patience. Did I say some people like the easy way out???HMMM!!
I'll try and find a picture or video so you can get an idea what the screw end looks like. It's actually pretty small. The newer ones have a coating on them to prevent tissue growth and allow electrical connection. Tech: They usually come in around 650 ohms old style around 350 ohms.

Here's a link to how the procedure is done. On it you'll see it shows tines at the end and you'll see how small the screw at the end is. I beleive the Medtronics leads have a sponge like material where the tines are in this article. This promotes tissue growth to hold the lead after placement these are buggers to get out after they been there awhile. Of Course Med-t has a laser sleeve to break this down and of course it costs big $$$$.


http://my.clevelandclinic.org/heart/ser ... tract.aspx

Here's a link of a actual placement lot of yak,yak and the procedure starts about 10 minutes into the video it's 1:05 hour long. Brush up on your Creole the operating Doc is from the islands!


http://www.orlive.com/halifaxhealth/vid ... layPageNLM