which direction?

Hi All,

So doc says he is fitting a pacemaker on the 18th dec. First he said he is fitting a meditronic advisa then he quoted on ensura. i think he did this because i am not on medical aid and thinks money is a problem. regardless of cost is there a difference( my understanding is ensura is the basic version of advisa). Also being young (31) and active should i consider sub-pectoral implant?

6 Comments

What for?

by golden_snitch - 2013-12-04 09:12:09

Hi!
What are you getting the pacemaker for? If it's sinus bradycardia with chronotopic incompetence (inability to increase heart rate when exercising), I'd not opt for a Medtronic pacer at all. Instead I'd chose a model with two sensors for heart rate adaptation, namely minute ventilation sensor plus accelerometer. Only manufacturers offering those are Sorin and Boston Scientific. What Carl mentioned, the rate drop response and the ATP, are some special features that many patients don't need. Rate drop response is mostly for patients with vasovagal syncope; ATP is for atrial flutter (at least that's my info from a Medtronic).

Being your age and having had both, a subcutaeneous and a subpectoral implant, I definitely prefer the subpectoral. Hurts a little more after the implant, but then you hardly see the pacemaker and it's a bit better protected when you exercise.

Best wishes
Inga

Very Similar

by CarlRobinson - 2013-12-04 09:12:29

Both MRI Conditional main differences are that the Advisa has Rate Drop Response Algorithm and ATP to treat atrial arrhythmias. The ensura does not.

J.B.

by golden_snitch - 2013-12-04 11:12:56

If you read my comment again, you'll realize that I only said I'd not opt for Medtronic when the rate response feature is needed. My first pacemaker was a Medtronic, and my next will probably be and currently I have a french-italian pacemaker. However, if you need a really good rate response, you have to go with other manufacturers because Medtronic does no longer offer minute ventilation sensor + accelerometer combination.

I'm definitely not saying that Dean's doctor doesn't know what's good for him. And my being German and living in Germany has absolutely nothing to do with all this. Gosh, what are you making up here???
I have no idea what Dean has, that's why I asked and then wrote that, if he should have a condition that requires the rate response to be switched on, in that case I'd not go for a Medtronic. And I explained two features that Carl mentioned. I explained them, I did not say that they are bad for Dean.

I have the impression that many doctors today suggest a MRI-safe pacemaker, and forget about other features that might be needed, too. Unfortunately, none of the MRI-safe pacemakers on the market at the moment has a rate response with two sensors.

Inga



subpec

by Tracey_E - 2013-12-04 11:12:57

If you are at all active, I would opt to bury the pm. Mine is buried and it never gets in the way. Healing is a little longer but it's not bad and imo well worth a little bit of extra trouble at first.

clarificaition

by dean20 - 2013-12-05 06:12:00

I was diagnosed in 2004 with server sinus brady and CI but over the past few years my doc says i don't seem to have a problem raising my heart rate and recently find out i have heart block. i asked for a boston sci but said if i want he can fit one but it was not necessary and a meditronic would work fine.

Dean...

by golden_snitch - 2013-12-05 12:12:56

... if you can exercise without any problems, then the chronotopic incompetence is apparently no longer a problem. However, since you were diagnosed with sinus brady and CI some years ago, I wonder if your cardio can guarantee that you're not going to get problems with this again. Anyways, the Medtronic pacemaker has a rate response sensor, too, which is an accelerometer. From what I have heard, among all pacer models that have accelerometer only, Medtronic's accelerometer is supposed to be pretty good; not as good as minute ventilation combined with accelerometer, but you'll still get a decent response to exercise, if you should need it. And in case you should ever experience severe chronotopic imcompetence again, and the accelerometer is insufficient, you can still get a different model when it's time for replacement.

What kind of heart block do you have, and is it permanent or intermittent? If it's intermittent, then the Medtronic pacemaker will offer you a very effective algorithm to reduce the amount of ventricular pacing to an absolute minimum (called MVP). Boston Scientific doesn't have that. So, that would also be a plus for the Medtronic pacer.

Inga

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