pacemaker and medical tourism

Hello everyone.

I am 42 years old and I have had extended episodes of ventricular ectopics since I was 26. The last three years they have been almost constant, and while the cardiologist has done all the checks and considers them benign, I find the symptoms very frustrating and am determined to have a pacemaker installed.

I live in Australia, and I am wondering if anyone has had experience with having the installation in Thailand or any other popular medical tourism countries.

Thanks

kind regards

Jennifer

10 Comments

Absolutely no indication

by golden_snitch - 2013-06-20 02:06:25

Hi!

Well, you might be determined to get the pacemaker, but the fact is: A pacemaker cannot do anything at all about ventricular ectopics! A pacemaker treats bradycardia, so episodes when your heart rate is too slow. It cannot treat ectopics, and it cannot treat tachycardia (heart rate too fast). So, stop trying to talk a doctor into implanting a pacemaker since it would be of no benefit at all. You might find an idiot somewhere who does it, although you have no indication at all, but the pacemaker will not help you with your ventricular ectopics - you'll find yourself in the same situation you're in now after pacemaker implant.

Best

Inga

ectopics

by Alma Annie - 2013-06-20 03:06:21

where in Oz do you live? I live in South Australia and have had my pm for 2 years. There really is no need to go overseas to have one. However, as Inga has said a pm will not correct ectopic beats. I have many of them and feel them, especially when I lie on my left side and it shows on pm data, but as you have been told they are benign, although annoying.
Someone on this site suggested eating magnesium rich foods, which might help. (It didn't for me)
If you have a pm inserted overseas I don't see how you can have it monitored regularly. I hope you will re-consider.
All the best
Alma Annie

Where you Live

by 2john - 2013-06-20 06:06:23

I agree, it's best to have your PM placed where you reside most because you need regular followup checks. I spend half my time in the Philippines. Consequently because of circumstances, I ended up having my pacemaker surgery at the Philippine Heart Center in Manila. Although they treat other medical problems, they're specialty is the heart. The PHC is one of the better heart centers in Asia. Many foreigners go there because of their expertise. The doctors and care is very good. I wouldn't say it's inexpensive but I have no regrets. Good luck.

A Second to what Snitch said...

by donr - 2013-06-20 06:06:48

...with a caveat. I had ectopics out the wazoo - I mean so many that I was effectively disabled & non-functional. My particular brand of ectopic was the lowly PVC (Premature Ventricular Contraction). There were times when I was running about 30% PVC's & that turned me into a zombie that could NOT stay awake. I even had runs of 50% PVC's that lasted for hours - witnessed & recorded on the ER monitor.

General rule - a PM CANNOT do anything about events that happen SOONER than they should - like a premature beat of any kind. A PM is an accelerator, not a brake.

Here's what my Cardio & EP (2 separate MD's, working together) did for me: Dosed me up w/ the highest dose of Beta Blockers I could tolerate w/ out becoming a true zombie. In my case, I am on 3 X 200 mg daily of a drug called Acebutolol (Sectral) to induce artificial Brady. This brings my HR down to somewhere in the 50's. THEN - I take 2 X 50 mg daily of an anti-arrhythmic called Flecainide Acetate (Tambor) to kill most of the PVC's. A godly number of the PVC's that aren't supressed by the Flecainide are taken care of by the PM, since they now will occur LATER than when my PM expects them to occur at my base rate set in the PM of 75 BPM. I still have a few PVC's, but at a max rate of about 1 - 2 per minute. That's several thousand per month, but I do not even notice them any longer. AT that low rate, you learn to ignore them.

Every now & then I will sense one of them - or perhaps I'll have a run of 4 or 5 & sense that.

You did not state how many of these unpleasant beats you have. How about letting us in on it - it may affect our comments, though it should be obvious that not many of us are favorably disposed toward PM's as a help for your situation.

No reputable or ethical cardio or EP is going to plant a PM & expose you to the kind of meds I have to take to control the beats - UNLESS they are very frequent like mine were. These meds are HEAVY DUTY & can have some NASTY side effects. Once you develop the side effects - you can NO LONGER take the meds, so this is sort of a last stop on the line before they are forced into even nastier solutions - like low probability of success ventricular ablations to help.

Tell me your frequency of occurrence & I'll give you a more specific comment.

Don

farewell

by jennifergraf - 2013-06-20 07:06:39

Well thank you, everyone for your knowledgeable contributions. Obviously this is a far more complex issue than doctor Google had lead me to believe, and, most likely, a pacemaker is not the quick fix I had hoped for- if indeed even relevant to my symptoms.

I will leave the group in a few days, in case someone has anything else to add.

I thank you for your warm welcome and support, and wish you all the best.

And, by the way, it does seem, as one of you mentioned, that it gets worse when I lie on my left side.

Regards

Jennifer

thanks for your responses

by jennifergraf - 2013-06-20 07:06:59

Thank you all for your responses.

Two years ago, I had a halter monitor for 24 hours during a period when the arrhythmia was moderate to high. The result was summarized as: Very frequent ventricular ectopics up to 397 per hour with occasional of ventricular bigeminy and trigeminy, and infrequent atrial ectopics about 6 per hour.

Since then I have tried Metaprolol which the doctor prescribed at the rate of 1 tablet up to 4 times a day. I have taken as many as 12 in one day and the only effect was to make me feel like I was walking slightly up hill in a dream. It had no effect on my arrhythmia what ever.

The severity of my condition increases with high levels of activity. I thrive on physical activity, bush walking, gardening etc but these days, I am afraid to move or do anything for fear of setting it off. During periods of high levels of arrhythmia, which, once set in, can last for days, I experience fatigue, depressive moods, sleeplessness, inability to concentrate, and a feeling of general ill health.

I have recently come to the point where I will do anything to stop it. Of course I have no intention of undergoing any medical procedures contrary to medical advise. But I am seriously considering all my options, including overseas. My past experiences with surgery overseas (not related to heart) have proven extremely satisfactory, and I merely wish to get the ball rolling and start researching the issue.

I have tried the various nutritional supplements to no avail.

Due to various other commitments and living in a remote area, I will not be able to make an appointment with a cardiologist for a few months, at which point, all options will be considered.

Meanwhile, I am grateful for the opportunity to connect with others who have had perhaps similar experiences, and thank you all who have already been so generous with your time for helping me learn to become informed.

Regards

Jennifer



Betablockers & arrhythmias

by golden_snitch - 2013-06-20 08:06:00

Hi again!

Don, in your case the betablocker didn't stop the PVCs, but generall speaking, a betablocker is what is usually prescribed when you have frequent PVCs, and in most patients it works very well. Just needed to correct this, because your statement that a betablocker will not affect arrhythmias is just not true - not for PVCs, not for all kinds of atrial tachycardia, not for atrial flutter, and not even for ventricular arrhythmias. Betablockers do have an affect on quite a lot of arrhythmias, and they are usually the first drug that is prescribed. I have been on betablockers for ALL of my many different arrhythmias. There are lots of members here who are on betablockers to treat arrhythmias, and when they read your statement, they might end up thinking that they are treated wrongly.

Jennifer, you say you want to weigh all your options. However, as several of us have stated here, a pacemaker is no option to treat PVCs. You have to understand that. I know many, many people who think that a pacemaker will correct every rhythm problem, but that is not true. The pacemaker itself won't do a thing about your PVCs, so please realize that this is no option for you.

Inga

Gray Area!

by donr - 2013-06-20 08:06:40

Jennifer: Comments by paragraph follow:

"Two years ago, I had a halter monitor for 24 hours during a period when the arrhythmia was moderate to high. The result was summarized as: Very frequent ventricular ectopics up to 397 per hour with occasional of ventricular bigeminy and trigeminy, and infrequent atrial ectopics about 6 per hour."

397 (rounded off to 400 per hour) is NOT a lot of PVC's - only about 6-7 per minute, or about every 9th or 10th beat. That is marginal for misery. the runs of bi & tri geminy are the items that catch my eye. THOSE can be debilitating & are what really shoved me over the edge as far as my EP being willing to treat me as I described in my comment.

"Since then I have tried Metaprolol which the doctor prescribed at the rate of 1 tablet up to 4 times a day. I have taken as many as 12 in one day and the only effect was to make me feel like I was walking slightly up hill in a dream. It had no effect on my arrhythmia what ever"

Metoprolol is a Beta Blocker & will NOT affect arrhythmias - it only slows the heart down. You need an anti-arrhythmic drug to kill the PVC's - like Flecainide. (or another drug.) The side effect you mention is about right - turns you into a zombie - NOT fun!


"The severity of my condition increases with high levels of activity. I thrive on physical activity, bush walking, gardening etc but these days, I am afraid to move or do anything for fear of setting it off. During periods of high levels of arrhythmia, which, once set in, can last for days, I experience fatigue, depressive moods, sleeplessness, inability to concentrate, and a feeling of general ill health."

Sounds about right. Especially the last sentence or two listing how it makes you feel.

"I have recently come to the point where I will do anything to stop it. Of course I have no intention of undergoing any medical procedures contrary to medical advise. But I am seriously considering all my options, including overseas. My past experiences with surgery overseas (not related to heart) have proven extremely satisfactory, and I merely wish to get the ball rolling and start researching the issue."

I know how you feel. BTDT! Have you talked to an EP - as opposed to a Cardio? The EP may have a different take on the rationality of using the Pm in conjunction w/ meds to help you out. You have a medical ethics dilemma! Asking someone in Australia to do follow up care on you for a device planted elsewhere. This is something that requires considerable follow up & tweaking of PM settings & drugs. If a Thai surgeon plants the device, who will monitor the meds portion of therapy? Most of the anti-arrhythmics have messy side effects & require constant monitoring. I'd say to get w/ a reputable Ep & discuss the issues I've laid out before you. Perhaps you are running afoul of nationalized medicine & its concern for cost vs efficacy for the treatment regimen I've suggested. IMNSHO, you have talked w/ a cardio who didn't seem to know all the issues involved in this particular protocol Perhaps Snitch will revisit your thread & comment on what I have suggested.

Again in MNSHO, you are living in a gray area of symptoms where the Dr thinks you need to just grow a spine & tough it out. Having BTDT, I can easily see your point of view & would probably be considering the same course of action. You really must get a local Dr aligned w/ you on treatment because you WILL need follow up help.

You have a tough row to hoe w/ this issue. Best of luck in your search for a solution.

Don

Interesting disagreement...

by donr - 2013-06-20 09:06:09

...on Beta Blockers. If I have lead you astray, I apologize - this is what my cardio described to me as the protocol for my PVC's & his rationale for what he did.

I will have to return to him & re-open the discussion we had when we began the trip down the road we have taken.

Inga, if what you say is COMPLETEY correct, why does it work for my situation? We agree COMPLETELY that a PM is not, by itself, a solution to PVC's. But when combined w/ appropriate meds can work effectively.

You have ruled out as unworkable the solution my Cardio & EP selected for me - a combination of the Beta Blockers, anti-arrhythmic drugs & the PM.

Even though Beta Blockers may be the first protocol of choice for treating arrhythmias, there are are also a sizable number of people for whom they do not work - like Jennifer, who took a fistful of them w/ no result, & several others who have talked about unsuccessful results - usually because of messy side effects.

Inga - thank you for chiming in again on this. If I am wrong, I need to know it.

Don

Don...

by golden_snitch - 2013-06-20 10:06:52

I know that there are some people for whom betablockers don't work, or only work in combination with other drugs. I just wanted to correct you saying that betablockers only slow the heart down and have no affect on arrhythmias.

If you have the pacemaker, because of all the drugs you need to keep your PVCs under control, and because those drugs in turn cause bradycardia, then this is one of the rather rare cases. Actually, you'd be the first person I've been hearing of who was treated with this strategy for PVCs. never read about a case like yours, either. When did your EP develop that approach? If it was like ten years ago or so, I'd have it re-evaluated. Ablation techniques today are much much more successful and can cure a lot more arrhythmias than ten years ago.

Here, if you have several thousand PVCs per day, at least 10.000-12.000 (many EP wants to see even more), you are offered an ablation, UNLESS those PVCs are multi-focal. If they all look the same, originate in the same spot, an ablation might do the trick. The right ventricular outflow tract is where PVCs often come from. This is the route I'd take for PVCs, instead of taking high dosages of strong drugs all my life plus having a pacemaker implanted plus a base rate of 75bpm. I know you're a bit anti-ablation, but they do work for PVCs, too; not in all cases, but it's still worth a try. Weighing costs or rather risks and benefits, an ablation is what I'd consider first. But, of course, if you have multi-focal PVCs, an ablation will not work. Don't know what type you have.

Yes, I was saying that a pacemaker is no option to treat PVCs. I'd only agree that it could be an option in case you have several thousand multi-focal PVCs per day that require strong anti-arrhythmic drugs which in turn cause bradycardia. I'm not ruling it out as an unworkable solution - but it's a very special & uncommon approach your EP has taken. Jennifer is not even close to the number of PVCs you have. So, I was thinking that she needs to know that normally a pacemaker can only treat bradycardia and is therefore no option when you have PVCs. I think most EPs would agree with that. If she consults a different cardio or EP in Australia or abroad, and tells him she wants a pacemaker to treat her PVCs, they will probably tell her the same as I'm saying here.

I have one more question for you because you wrote:
"A godly number of the PVC's that aren't supressed by the Flecainide are taken care of by the PM, since they now will occur LATER than when my PM expects them to occur at my base rate set in the PM of 75 BPM."
- What does your pacemaker do about those PVCs, and what do you mean by "later"? They're still premature contractions, aren't they? I know some pacemakers can suppress the pauses that occur after PVCs (compensatory pauses), and some respond to PACs by speeding the heart rate up a bit, but what your pacer does, I don't understand.

Always great to discuss things with you :)

Inga

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But I think it will make me feel a lot better. My stamina to walk is already better, even right after surgery. They had me walk all around the floor before they would release me. I did so without being exhausted and winded the way I had been.