Biotronik vs. St jude pacemaker

I already have a dual chamber pacemaker (Biotronik) I have tried every med with no avail and currently have AV dissociation and a type of pacemaker syndrome at that time where Wenckebach is occurring, and there is atrioventricular dyssynchrony. We are planning on AV Node ablation as I have had 5 other ablations within the last 2 years for flutter, av node reentry, svt. The question I have is the Biotronik only alerts the doctor, can not show ecgs to them as I have to go in to see them. The St Jude would give the doctor the ecgs right away if they were to change my pacemaker. Looking for thoughts and input on if we should change the pacemaker so they can watch it more carefully once Im totally pacemaker dependent. Thanks for your input.

14 Comments

Pacemaker

by golden_snitch - 2014-08-02 03:08:15

Hi!
First of all, the Biotronik can show ECGs, too. It can even record ECGs when the patient feels like there is something wrong (patient triggered recording by shortly putting a special little magnet on, I think). Secondly, you do not need closer monitoring just because you had an AV-node ablation that caused a complete block. Lots of patient have that block, and there is nothing special or risky about it. Also, even after that ablation, you will have an escape rhythm. I had 8 ablations, incl SA- and AV-node and I have a ventricular escape rhythm of around 40-45bpm. Pacer dependency is a term defined very differently. I'd use it only for patients who have no escape rhythm at all. Last but not least, of you need the rate response, you are much worse off with St. Jude.
Best wishes
Inga

Sending ECGs

by golden_snitch - 2014-08-04 05:08:34

Kim,

the thing is, once you had the AV-node ablation, what kind of ECGs do you want to record and send in? If your atria are acting up again, it doesn't matter any longer, so you do not need to send ECGs documenting atrial arrhythmias (and for atrial fibrillation or flutter, an alert should be enough).

Also, if you ever need the rate response on - for instance, when the atria are in a permanent arrhythmia, so that you are switched to VVI pacing -, St. Jude is really not good. It works with one sensor only, and what I have heard about this "accelerometer" is that it's definitely not a good one; if you opt for accelerometer only, then at least get a Medtronic device with a good one. Other devices, like Biotronik and Sorin, work with two sensors for rate response.

Are your leads failing or why do they want to take them out? Taking out leads is not a risk-free procedure, and it's usually only done when there are too many faulty leads in already, so that there is no room for a new one.

I have a Biotronik Evia, and it has a "patient trigger" to record episodes when I don't feel well. I haven't asked Biotronik for the magnet that is needed for activation, yet, though. Not sure about sending ECGs; I know it can send periodic IEGMs (intracardiac electrogram). And I just read that their new device, the Eluna, can definitely send event-tiggered IEGMs:

http://www.dicardiology.com/article/world%E2%80%99s-first-pacemaker-series-event-triggered-iegm-transmissions-gains-ce-mark

Inga

pacemaker

by Thunder6 - 2014-08-04 09:08:55

They want to do an av node ablation.. They discussed putting in a new pacemaker...I'm unsure if I should since it is so...final..so to speak. I guess I was wondering if anyone else has had this issue and how it was dealt with? I am the guinea pig here....which I hate.

Kim

Continuation...

by Thunder6 - 2014-08-04 12:08:46

Sorry, I am not able to record from the biotronik if I notice a problem, that is not possible unless I use cardionet or the Bodyguardian device from Mayo Clinic.

Thanks
Kim

pacemakers

by Thunder6 - 2014-08-04 12:08:49

I know they show it, but not online, I have to goto the Dr. ofc so that they can download it..I have been told by Mayo and the reps that it is impossible to get a direct ecg from the device, only alerts and then I have to go in. I have been doing this for 1 1/2 years and am quite frustrated. I continually have wenckebach with the dual chamber pacemaker, which someone I have a type of pacemaker syndrome. What I have been told is that av node ablation will fix the dyssynchrony of my heart plus the av dissociation and the wenckebach. Am looking for thoughts as I am also being advised a St Jude pacemaker would be better at this point. Not sure if insurance will cover this and am looking for advice, as they want to take out my old leads which are only a couple years old and put all new in when the switch the pacemaker. A little history with my problem is I was in a car accident in 2009 which I broke my C6, not severed, all healed without surgery. Problem is my nerve that controls the electrical of the heart runs right along C6 and no one knew that for 2 years my heart was having problems. I was diagnosed with every other problem except for the real one and now there is damage in my heart because of it. I am only 6 out of the country..per mayo...that have this problem so unfortunately my case is a bit more complicated. My rate response is off as of right now. Any thoughts on changing the type of pacemaker so that when there is an alert the doctor can pull up the ecg automatically instead of calling me in? What pacemaker is best for pacemaker dependent people? Thanks for your input.

AV-node ablation

by golden_snitch - 2014-08-05 03:08:53

Kim,

then ask this question here. You asked about changing pacemaker manufacturers.

I had my AV-node ablation because of accelerated junctional rhythm/tachycardia with retrograde VA-conduction and AV-dissociation. My ventricles were beating faster than my atria or at the same time. When I was off all drugs, I had this problem for long periods at rest, and almost always when I moved around. My junctional rhythm was able to do 140bpm or more. I was on drugs for four years before I had the AV-node ablation, which was my 8th ablation. Don't know what you have tried so far. I tried: Nebivolol, Flecainide, Flecainide + Nebivolol, Propafenolol, Propafenolol + Nebivolol, Amiodarone, Dronedarone, Sotalol, Verapamil. Some of them bought me a couple of months or a year time. But in the end they all failed. So, I first had an AV-node modification, and when that failed, too, I had the AV-node ablation that induced a complete block. I'm doing better now, the ablation was back in 2012.

The one thing you need to realize is that, if they ablate the AV-node, and you get atrial arrhythmias again, you will likely be switched to VVI pacing, which ignores the atria. So, that leads to AV-dissociation again, and this time the atria might be going faster than the ventricles. Could happen that you do not tolerate the VVI pacing. I'm still in DDD-CLS, so I cannot tell how VVI pacing feels.

Inga

av node

by Thunder6 - 2014-08-05 04:08:48

They tried VVI on me already by setting my biotronik pacemaker that way, I did not tolerate that. I too have had the drugs you mentioned plus others with no avail. I also have retrograde VA conduction and AV dissociation along with some type of pacemaker syndrome even though I have a dual chamber pacemaker which the doctor advises is not common but has been caught on the ecgs. Have had 6 ablations..av node reentry, flutter/fib/tachycardia. The tachycardia is better but still occurs however the dissociation is driving me nuts. I feel like I can't breath, chest pressure, nauseous, chest pain. I have become the guinea pig at Mayo. I feel he wants to try the av node ablation and is not certain it will take care of it. I have read other posts that stated they still had the same problem after av node ablation. Just don't know if I ignore it and deal with it or try the ablation. av node ablation is so final but I know its not good for my heart to not be in sync so I struggle with which is going to affect my heart the most/or make it worse. They want to switch pacemaker brands due to my brand not sending ecgs to the doctor, only alerts, which then I have to physically go in and get them read. That is the problem with my Biontronik pacemaker EVIA drt, it alerts them but cant show them anything and if I am going to be pacemaker dependent they want something that they can see whats going on instead of calling me to come in each time. They also want to change out my leads as I am only 45 and they feel if they start leaving them in, I will have too many as I get older and its safer when younger to take them out instead of when I am older. What is your take on that? Thanks for your input :)

Leads

by golden_snitch - 2014-08-05 05:08:14

Hi!

I'd not replace perfectly functioning leads. There are patients whose leads are fine for 20 years! Who knows how long your leads are going to last, maybe you are one of those who have their first set for 20 years. And there will be lots of technological progress in 20 years. I mean the first leadless pacemakers are already implanted today. You might never need new leads.

Of course you have a pseudo-pacemaker syndrome, if you have an AV-dissociation with retrograde conduction. A "normal" pacemaker syndrome happens due to bad timing between the atrial and ventricular pacemaker impulse, the chambers are not in sync; in your case it's not the pacemaker's fault, but you have a fast AV-node/junctional rhythm that leads to the atria and ventricles beating out of sync = PSEUDO pacemaker syndrome. I had this, too.

VVI pacing, as long as your AV-node is working well, does not make a lot of sense. The situation, once the AV-node is ablated, will be a completely different one. If everything works out well, you won't need VVI pacing, but can stay in DDD. If your atria act up again with atrial tachycardia, you'll be switched to VVI pacing. Unlike now, the atria will then probably be beating faster than the ventricles. It is not said that this feels the same way as when the ventricles are beating faster than the atria. All I was saying is that you might not tolerate this kind of pacing, but you cannot say for sure, until you have tried it - and you cannot try it as long as the AV-node is intact.

My AV-node ablation was done at Germany's largest EP department. My EP professor and his team do more than 2800 ablations per year. We discussed AV-node ablation and all its risks many times - alone, and with the whole team. You won't find any EP who guarantees you that this ablation is the key to success - mine didn't either. I was fully aware that there was a 50/50 chance that it would help. So far, I was lucky. But my EP and I know that this might not work forever.

I have the same problem as you or even a bit more complicated, because I had more arrhythmias, had superior vena cava syndrome, have epicardial pacemaker leads, am on blood thinners. BUT my EP is not at all worried about my pacemaker not being able to send him ECGs. Actually, I'm not even home monitored at the moment. We know that, if something's not right, I'll be able to tell, and then we'll check the pacemaker and do a holter monitor. I can imagine that some pacemakers might send in atrial high rate/afib/aflutter episodes. Don't know why your EP wants ECGs of those after having performed an AV-node ablation. I mean, as soon as you go into atrial tachy again, the mode will be switched to VVI, and then it just does not matter any longer what the atria are doing. If you should go into Afib, an alert will be enough, so that they can put you on a blood thinning medication.

How often do you go into dissociation? If you say you might as well try to ignore it and live with it, it sounds a bit like it doesn't occur all the time. When I had my AV-node ablation, I was in AV-dissociation all the time when I moved, and for long periods at rest, too, every day. I also had pacemaker-mediated tachycardia at that time due to the retrograde conduction. I could not even take a few steps without arrhythmias.

Inga

Alerts

by golden_snitch - 2014-08-06 02:08:32

The alert will tell them at which rate the atrial or ventricular high rate episode was running. Usually, anything above 400bpm in the atria is Afib. I think, if you chose a device, there are much more important functions than the kind of alerts you can have. I'd always do a holter anyways to confirm any arrhythmias the pacer has detected; pacemakers are too prone to detecting artefacts. But that's just my opinion. Also, as far as I know Biotronik is to date the only manufacturer whose home monitoring is automatically sending in reports, without any help from the patient. It just transmits them at a fixed time every day. In other manufacturers the patient needs to activate the transmission.

You pace 85% in the atria without the rate response on? That's odd, because it means you are paced at base rate 85% of the time. Maybe switching the rate response on, and increasing the base rate would help. That way the accelerated junctional rhythm causing the dissociation would probably be overdriven, because the pacemaker is faster.

There are different settings with regards to how the pacemaker reacts to atrial high rate episodes. It can also go into a 2:1 block when the atrial rate is too high. And it can switch from DDD(R) to DDI(R), so that sensed atrial events are not automatically tracked by the ventricular lead. The ventricular lead only kicks in, if the rate drops below the programmed base rate (and then you have VVI pacing).

Inga

Pacer

by Thunder6 - 2014-08-06 08:08:28

They had the rate response on which didn't fix anything. My biotronik downloads every night at 2:30am but only alerts them of a high rate. It is unable to give them an ECG..that is the only problem with the biotronik. They have been tuning my pacemaker for 1 1/2 years with no success.. My heart has a mind of its own which is y the choice to ablate the node is last resort only I'm not positive it will change anything as I seem to have terrible luck. Funny u said the word strange when describing my rates.. That's why mayo calls me unique! Kim

av ablation

by Thunder6 - 2014-08-06 12:08:36

Any time Im at rest Im in AV dissociation. It wakes me at night, this is when I'm usually having the Wenckebach episodes. I know my Dr. didn't think that I could be having Wenckebach, but I just finished a 30 day monitor with the Mayo Clinic's new Bodyguardian and it caught them which surprised my Mayo doctor. According to Mayo I am one of 6 people recorded that has the issues I do. They call me unique and my hometown doctor called me an anomaly so gee I'm so glad Im special..HA. I am so tired of being a guinea pig. If I can purposely keep my heart rate up, by just not stopping so to speak, going all day without resting it doesn't bother me as much but still occurs as soon as I sit. I work out 3x times a week but a lot of the time its like my legs cant even move, they become so weak and I've always been active and exercised. Was always a runner which the doctors say have helped me do as good as I do now after all of the heart procedures etc. I still have the high ventricular rates that my pacemaker alerts on, about 30 a month, which has increased over the last 3 months. I am currently 100% ventricular paced at this point and my atria is paced around 85%. All of my problems occurred from a car accident that I was in back in 2009. It took 2 years to figure out it was the nerve that runs along my C6 that had been broke in the accident, was injured and caused electrical problems to the heart since that is the nerve that does that. My C6 wasnt severed and I did not have surgery to fix it, just a brace for 3 months till it healed. No one knew that the nerve was damaged at the time, over time however it has been the culprit of all my problems as I have never had problems and been in the best health. I spent 1 1/2 years being told it was my blood pressure when actually it was my heart causing the problems all along. There was even talk of cutting that nerve in my neck but only 2 people have ever done this and this has been just recent so I would like to know how they do before doing that as this is also final, cant reattach a nerve after you cut it. The problem is I'm quite tired all the time then and this then makes av dissociation worse when I do get home to relax. My AV dissociation occurs daily, basically anytime I sit it occurs, driving, sitting at my desk, or otherwise but Im just a bit hesitant to get my av node ablated. So if my atria started the tachy again, my Biotronik would automatically go into VVI? I think they want to know about the afib though, as the alert only says high ventricular pacing/atrial pacing, not what type of arrhythmia it is so then again I would have to get called in to go see them to get it downloaded. If they could get an ecg wouldn't that save a lot of time? Just trying to look at all options and risks before making my decision. I already know my AV node is very bad, it goes from 120ms to 430ms, no consistency it is vary irritable.THanks for all your info.

Kim

by golden_snitch - 2014-08-07 03:08:05

I have perfectly understood that the pacer is not sending ECGs, only alerts. BUT an alert is enough for Afib. The alert tells them how high the rate got, and from that they can tell if it was Afib (> 400 bpm in the atria is Afib). God Gracious, your doctor is really acting up on this "problem" of the pacer not being able to send in an ECG! Just do a holter monitor, it's more accurate anyways.

By the way, if you google St. Jude Merlin (remote monitoring) it does NOT say that it sends ECGs, only alerts. So, no idea what your doctor is talking about.

http://professional.sjm.com/products/crm/connectivity-remote-care/remote-care/merlin-home-transmitter

In fact, Biotronik seems to be the first manufacturer that offers IEGM event transmissions in its new Eluna pacemaker:

http://www.biotronik.com/files/112B06DFBEC11A6BC1257CA800406BE8/$FILE/BIOTRONIK_PR_Eseries_CEMark_1st_Implantations_EN_final.pdf

Inga

Pacemaker

by Thunder6 - 2014-08-07 03:08:07

That's the problem I do not have Biotronic Eluna I have Biotronic Evia DRT... I'm about ready to stop trying to understand and let them do whatever they want..what ever happens will happen. I have read so many posts maybe I should just stop my research even though what they want to do doesn't make sense. Or I could just not go back and when my battery is dead then I won't worry about it either as I'm so tired of dealing with it. It has only caused me to feel worse most of the time so maybe not worth the worry anymore and I'll ignore it as good as I can. If the specialists can't get it right then I'm just screwed..

Kim

by golden_snitch - 2014-08-07 04:08:05

Yes, you have an Evia. Butyour doctor tells you that a St. Jude is better because it sends ECGs, so he wants to replace your Evia with a St. Jude. According to St. Jude's Website that is WRONG, it does NOT send any ECGs, only alerts (just like your Evia). That was my point.

Inga

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