pacemaker algorithms are crap

I had my pace maker adjusted to the teeth. After the first three months, I had a period of six month adjusting roughly once every two months. Not to mention the trips to the hospital. Finally it was adjusted by a group of physicians while I was connected to an echo cardiograph. That process took several hours of taking samples and running the data in a computer program then changing the adjustments.
I am a software engineer that write kernel code and worked on embedded system for over 15 years and I can tell that complexity it not needed in my case. The product should have been two products. In life critical application as a pacemaker, simplicity is a must.
It seems to me that complicated adjustments were necessary to recover flaws in the design.
Since my pacemaker is still is acting up tells me that it is crappy, hardware software or otherwise it makes no difference

7 Comments

pacemaker settings

by nkhalil - 2009-09-07 08:09:04

Hi Thomas,
I am glad it worked for you. I went after the elaborate settings several times and did all the diagnostics but they are still clueless. The pacemaker even showed some events of high heart rate of 130. I have seen multiple doctors sense and I still do not have an answer.
It sounds like my pacemaker is a piece of junk but I am still living with it
Of course Medtronics is not going to admit that their pacemaker is a piece of junk, neither the docs
Docs keep telling me it is AFIB but I never had AFIB
Here I am sitting down at 10:30 in the evening just watching TV then all of the sudden my pulse goes through the roof and I had to spend the night in the hospital?

pacemaker settings

by thomast - 2009-09-07 08:09:25

Six months after I had a 3 wire bi/ven resync unit installed I went in to have it optimized. Had been feeling good until then. I struggled with it for a month thinking it would get better, but it did not. My wife finally told me I need to to go in and have it reset to the original settings. I did, while they were resetting it I told them about how I felt worse after it was optimized. They replied and I quote, (they did get a little extreme when they set it). After being set to the original settings I felt much better. It has been four years and have been doing good. So you have to watch what is going on all the time.

Thomas

Crap

by golden_snitch - 2009-09-08 01:09:29

Hi!

I don't think it's all crap because there are lots of patients doing very well with a Medtronic pacer. I used to have one myself, and yes it did a lot of time to get the settings right, but that's normal. It took time because I'm young and active and have a very complicated history of arrhythmia that kind of challenges every pacer. Believe me, going in every two months for adjustments is something I dreamed of - I went in every two or three weeks.

Today's pacers do have lots of fancy features, and not everyone needs those. My cardio says it's sometimes just better to program the basics manually. Most of the fancy stuff can be turned off.

I don't know why you got your pacer (you didn't reply to frank's and my posts in the last thread you opened). If you have atrial fibrillation that would surely complicate the programming and make you feel bad. Why don't you let them show you the ECG next time they tell you you are in atrial fibrillation? Just because you have never had it before, that doesn't say that you will never get it.

I understand that you are angry and frustrated. It's definitely sub-optimal what you are experiencing. However, sometimes it just takes time to get settings right. Patience is needed, and a good attitude. I believe with all your frustration and anger, it might never get better. When you hate the device you have inside your chest, you'll always find something to complain about. A cardio once told me that she saw most pacer problems in those patients who never wanted a pacer so probably there is something about attitude.

Best wishes,
Inga

Problem is with the docs

by ElectricFrank - 2009-09-08 01:09:46

You may well be right in saying you don't need the complex algorithms that are built into your pacemaker, but they can be turned off if not needed. Sure, they could build simple units for those of us that don't need the complexity. Keep in mind though that cardiac problems have a tendency to change over time and often there is a requirement to make changes in the function. How would you feel if after going through an implant you were told in a few months that it was going to have to be replaced with a different one?

OK, here are some thoughts. Feel free to give me hell if you don't like them.

1. So far you haven't said what your condition that requires the pacemaker is. You say you don't have afib. How do you know that?

2. Afib is a possible candidate for your intermittent tachycardia. If the atrium goes into a fibrillation mode either the natural AV bundle or the pacemaker can conduct the rapid activity to the ventricles and create the tachy.

3. The natural pacing systems of the heart are very sensitive to the parasympathetic nervous system mediated through the vegus nerve bundle. Emotions such as anger can trigger bursts of tachycardia via this route. I can understand your anger about the whole situation, but it may be at least part of the problem.

best,

frank

Algorithms

by pete - 2009-09-08 02:09:47

The Algorithms (written program code) in your pacemaker are there for a purpose. Modern pacemakers are adjustable in ways that were unthinkable during the first 2 decades of their use. I have seen docs and technicians scratching their heads with the operation of some medical machinery. One machine was brought to my bedside and I was astonished at the number of weird buttons it had on it. The doctors really struggled to press the right buttons. I cannot help thinking of my days in the computer industry where one well known American manufacturer paid its software engineers on the number of lines of code they could write in a week. The result was very slow cumbersome software that was not what the customer wanted. There needs to be a balance between complexity and facility of use. I have not seen a specific pacemaker manual so I dont know if things are getting too complex at the moment. It might just be that its the complexity of your heart condition that is making helping you with a pacemaker difficult. Not all pacemaker patients benefit from their pacemaker. I was told that I might not benefit from a pacemaker, but thank god I benifited greatly.Electric Frank has made some wise comments. Cheers Peter

In love with technology

by bobad - 2009-09-08 10:09:11


nkhalil,

I think some docs are in love with technology for its own sake. Technology is certainly good, but cutting edge tech can be unreliable and unpredictable. PM salesmen show up with new tech and sell the docs on the benefits and possibilities, and the docs don't always give enough weight to the negatives. We all know how flaky beta software can be, and hardware is just as unpredictable.

Another consequence of cutting-edge technology is, docs are starting to rely on the PM techs. They seem to be adopting the attitude that PM technical problems are not their problem. That's a price we pay for exploding technology.

At some point, the doc needs to say "Enough!", and stay with technology he understands and is comfortable with. Technology should march on, but not out of control.

Another problem is time. Docs will not devote more than 20 minutes per visit with a patient. If tuning and adjusting cut into that time, it simply won't work. The docs are forced to delegate part of their responsibility to nurses and techs.

Good luck nkhalil!

Complexity is not necessary in most cases

by nkhalil - 2009-09-08 11:09:40

Hello All,
The best solutions are the simple ones. There is a need for complexity sometimes in technology but in the pacemaker case those should be different products.
In Thomas case the basic settings were enough. I bet that the complex features did not have enough test coverage.
The saying goes in the software business that you test your self out business. if you calculate all the test cases to get 100% coverage it will be a huge number that is not feasible to test.
I know that all of us are in debt to technology to be alive but that does not mean that we should not improve or criticize technology for its flaws.

Other commented that it is the docs fault that they do not understand what they are implanting but this is the responsibility of the pacemaker vendors to educate both the patient and the docs.
The pacemaker vendors are driven by product features in a free market economy as well. That does not mean that we need all the features in one device.
It is a tough call and the problem has multiple dimension.
I hope that your comments will drive some critical thinking from the pacemaker vendors in their new product line and that the vendors would better educate the docs about the technology and the limitations of the technology.
However my pacemaker is still a piece of junk.
Good luck to all

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