what should i do

Hi All,

I have been doing my own research and also with the help of several on this site have come to the conclusion that the correct and only pacemaker for me with sinus brady and chronotropic incompetence is one made by Sorin Or Boston Scientific with dual sensor rate response.

What should i then do if the doc recommends another brand?

11 Comments

Have meaningful discussion

by Jonny - 2013-11-13 06:11:35

I would suggest the obvious i.e. have a discussion with him and ask why he chose the model he has and why he wouldn't recommend your options. Docs have a hell of a lot more experience, but are sometimes wrong.
Let us know what happens.
John

Bear in mind regulatory approvals

by philip.thecyclist - 2013-11-13 07:11:53

I recently had a Boston Scientific PM wich combines dual accelerometer and minute ventilation sensors with CRT (cardiac resynchronisation therapy) which permits both ventricles to paced. The BS device did not achieve EU regulatory approval until April this year, and at that time had not yet been granted US approval. Like you, I had done my own research and had concluded that this was the only device yet to have such a combination. It might be worth questioning your doc about the regulatory regime in your location and whether this is limiting his choice.

Philip

What kind of system do you have in South Africa?

by donr - 2013-11-13 08:11:08

That's going to determine the ultimate outcome of your quest for the PM of your dreams.

Have the discussion - push like the Devil for it, but in the end, it comes down to what your system will allow.

I live in the US. My cardio has but ONE PM host carrying a Sorin. He has a few more w/ BS. He coud easily be convinced , but your docs.i don't know.

Don

Prefered Brand

by Bill T - 2013-11-13 08:11:48

In my case I'm on my second PM, (the first was a dual chamber and he upgraded to to a CRT-D when I needed a AV Node Ablation for A-fib and low EF) both have been St Judes. My Cardiologist does his own interrogation and tweaking and is intimately understands the in and out of St Jude models. Also he trains his PAs to interpret and adjust the units. In my opinion he is the best heart doctor here in NW Arkansas. I would suspect that most Cardiologist/EPs have a favorite brand and that is what they are most comfortable implanting.

Dean, its you body and money so I don't see any thing wrong with asking for an explanation/reason why he or she wants to use a different brand but I suspect that most of us will agree that all modern units are excellent and your doctors plans on using the one he is most comfortable with that will fit you needs.

Best of luck to you,

Bill T from Farmington Ar

Good motion sensors

by lbdina - 2013-11-13 09:11:43

Both companies are reputed to have good dual sensors, accelerometer and minute ventilation. They work together to help replicate the response of a healthy sinus node. I have a Sorin Reply DR, but I am fairly new to it. The rate response is turned on but it needs some minor tweaking at my appointment today.

Doctors have their favorite brands. I'd think it would be important to have a knowledgeable rep from the pacemaker company in close proximity, otherwise the cardio or EP might be flying solo with a new model they don't fully understand. The Sorin rep programmed my PM and will be present at my appt today? Sorin isn't as popular across the US as many other manufacturers, it's a smaller company. Worth thinking about this do you get the best possible support.

discussion

by Tracey_E - 2013-11-13 10:11:06

As the others said, have a candid discussion about why the doc is recommending another. Ultimately it's your decision. Sometimes it's habit, sometimes he knows something we don't, it could be he recommends what he knows best, sometimes it's proximity to good reps. A pm is only good if you have someone who can program it for you so if you aren't near someone who can service Sorin or BS, you probably want something else.

I know someone who switched from BS to Medronic not because the BS wasn't good, but because the local BS reps were very limited and not able to get her feeling as good as she could. She switched to Medtronic because they have a lot more reps in her area, and she's doing well now.

I'm on my 4th St Judes and have an excellent relationship with my rep. My dr suggested switching to Medtronic last time because they have one with a feature that may have been helpful. I thought about it, but wasn't willing to start over with a new rep.

I agree with Tracey

by Grateful Heart - 2013-11-13 11:11:10

For me now....the #1 concern regarding which device would be the rep and their knowledge of the device over the device itself.

I had a very bad experience with a rep right before surgery. He did not want to do his job....I don't know why he showed up at the hospital. He wanted to just use a magnet to shut off the defibrillator instead of using the programming. The hospital could have just used a magnet, without him. On top of that, he was going to leave before the surgery was completed....wasn't planning on staying or rechecking the device after the surgery. The hospital wasn't thrilled with him either. They had to keep paging him to come back when the surgery was over. My husband saw him in the cafeteria....just sitting there.

I need another procedure but I am hesitant now as my concern is will this same rep show up, because if he does.....I'm out of there! I can not trust him with my heart.

I'm giving you my real life example to illustrate how important it is to have a good rep. Something I never realized until this happened. A good rep is worth their weight in gold, imo.

In fairness, I have had a few good reps too but it is not always the same rep that shows up.....I wish it were.

Good luck to you,

Grateful Heart

Hi Dean

by IAN MC - 2013-11-13 11:11:39

I see you are in Africa so who is the decision- maker where you are and who does the PM checks ?

Many of the above replies are US orientated. Certainly here in the UK manufacturers' reps have no patient contact and would not be viewed as an unbiased source of info..I believe this applies across Europe and possibly in Africa ?

Ask your decision-maker to give you the pros and cons of each available make !

Cheers

Ian

Best of luck!

by IAN MC - 2013-11-13 12:11:18

It doesn't matter at all which PM you get to handle your bradycardia, every one will produce extra beats when your HR gets too low but there are differences in the way they handle chronotropic incompetence.

Some makes seem to have more sophisticated RateResponse mechanisms than others but none seem to be perfect. Our regular contributor from Germany , Inga, is particularly knowledgeable.

Whilst it is handy having access to a Boston rep, don 't forget that his / or her mission in life is to sell more Boston PMs; a pity that you don 't have a Sorin rep living locally a well.

Ian

can u believe?

by dean20 - 2013-11-13 12:11:43

I am from Zimbabwe and our local cardiologists cannot fit pacemakers so I fly across the boarder to South Africa where my current doc is. Well as it turns out I have a Boston sci rep round the corner from the hospital in south. I have emailed them. Fingers crossed. So when I go to my doc I will be well informed. Thank you all.

It's already been said...

by PacerRep - 2013-11-14 09:11:25

But if your doc wants another brand, just tell him no. He will say they are all the same etc etc, but in the end....they are not. Both of those devices are good devices...The boston is better at managing neurocardiogenic syncope while the sorin is better at not pacing the ventricle and has a stronger battery.

Sorin is not available in all parts of the country if your in the US. Your doc may not know about them, but you can always call the company and ask them if they have rep's in your area and where they implant...So if they implant at John Dough Hospital, you would request to have your surgery there if that's the brand you want....

Same goes for the Boston's, you have to make sure they have a contract at your hospital. Hospital's will sometimes only allow 2 companies in so they can smash their prices and get the devices cheaper, if that's the case then you can only get those 2 devices if you have your surgery there.

Good luck

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