NEED HELP ON BRAND & TYPE OF PM

This is my first posting. I'm scheduled to have a PM inserted June 17 at the Huntington Memorial Hospital in Pasadena, California. I have slow heartbeat and need advice on:
1. Brand: Medtronics, Saint Jude, or Boston?
2. Single or dual?
3. Rate responsive?
4. Outpatient or stay at hospital?
5. Other issues.
I did lots of research and found out that I need a PM and actually want to have one. I went to a cardiologist who had me wear a Holter monitor in 2011. It wasn't yet time to install a PM. But this year, I was examined again and my doctor recommended that it's time. I agreed and we scheduled procedure for next week. I'll appreciate your tips. Thank you.

6 Comments

Some answers...

by golden_snitch - 2014-06-09 03:06:26

Hi!

What's your diagnosis? A slow heart beat can be caused by sinus node issues, but can also be due to a heart block.

With a heart block the rate response sensor - every pacemaker has one, just which one varies - usually doesn't matter that much, because you won't need it. Your sinus node will dictate the pace. But if your sinus node is too slow, and you can also not bring your heart rate up when exercising, then which rate response sensor is one of the most important decisions. In that case, I'd go for a blended sensor combining an accelerometer with a minute ventilation sensor. Brands that offer this combination are Sorin Group and Boston Scientific. Biotronik has a CLS (closed-loop stimulation) sensor which would also be a good choice, but only for patients who are active and exercise regularly, according to my experience. All other manufacturers have an accelerometer only.

Single or dual-lead depends on your diagnosis. Most pacemakers implanted today are dual-lead, even if the patients need ventricular or atrial pacing only, and not both. With sinus node issues, however, a single-lead atrial pacemaker totally suffices. By not adding a ventricular lead, you completely eliminate the risk of being paced in the ventricle, and you leave more space in case that atrial lead one day needs to be replaced. After my sinus node ablations I had an atrial pacemaker implanted, and lived well with it for 9 years. With a heart block I'd go for a dual-chamber device, though.

Outpatient or inpatient? I always stayed inpatient for a couple of nights, because pain management was better at the hospital. Which brings me to another issue: placement. I have mine subpectorally, so under the muscle, and that hurts a lot more initially than when you have it put under the skin only. This is something you should think about, too. Most patients have it under the skin, and do well with that. However, if you are very active or rather skinny, a subpectoral placement might be better for you. The device is less noticeable and better protected when you exercise.

What pace-man said about the MRI compatible pacer is also worth considering.

Hope this helps. Good luck!

Inga

good luck

by pace-man - 2014-06-09 03:06:55

Good luck and I hope all goes well for you, at least you get to choose your pacemaker , I had a Biotronic pacemaker fitted late last year , it seems to work ok , I wake up alive every morning , so that is always a good sign.
Make sure you get a MRI compatible pacemaker and leads. I know the Biotronic that I have is MRI compatible
Pace-Man.

drs vary

by Tracey_E - 2014-06-09 09:06:34

1. Most hospitals in the US have contracts with one or two companies, so your dr will choose one of those. Typically, the dr chooses the one he knows best and has the best relationship with. There are some nuances between them but unless you need the features Inga mentioned, you will be fine with any of them. My dr has always chosen mine. I'm on #4 now.

2. Depends on your diagnosis but most of us get dual lead. Even if you don't pace with both, it is helpful to have the information from both. In my case I have av block and could have gotten by with just the lower lead. Turns out I have a second problem that was masked by the block, so I pace with both leads. I'm glad I have both.

3.They are all rate responsive but as Inga discussed, some work differently than others. If you have av block or anything else where your sinus node responds appropriately on exertion, you won't use rate response.

4. Overnight is standard in the US

5. Placement! Ditto Inga again, if you are active you might prefer it to be buried a bit.

big names

by Tracey_E - 2014-06-10 04:06:42

bradycardia means your heart rate gets under 60. All of us have that, it's more a symptom than a diagnosis

3rd degree av block is the same thing as complete av block. The sinus (SA) node is in the atria and is our natural pacemaker. It's the brains, it senses the oxygen levels in the blood and raises/lowers the heart rate accordingly. The ventricles are the brawn, they make the hard contraction we feel as our pulse. The SA node tells the AV node in the ventricles when to beat. AV block is when the signal gets blocked between the SA and AV nodes. Third degree means it's blocked all the time so the ventricles are beating at random, unrelated to when the atria beats.

sinus brady means the slow rate is coming from the sinus node, which is sort of the opposite of av block. Most have one or the other but both is possible. I don't understand QRS well enough to explain it, it has to do with the delay. Here are some great explanations of how the heart beats, the most common reasons we need paced, and how the pm works
http://health.sjm.com/arrhythmia-answers/videos-and-animations

Sophisticated rate response is only important if your sinus rate doesn't go up appropriately with exercise. If your rate doesn't go up because of av block, then you won't need rate response. In that case, your sinus rate is going up normally but the signal isn't getting to the ventricles so all you need is for the pm to complete the broken circuit and make the ventricles beat when the atria does.

p.s. it doesn't really matter what your diagnosis is. All of the things you mentioned are fixed with the pm! Don't let multiple names bother you.

Thank You for your Comments

by CHUBS - 2014-06-10 11:06:58

Thank you all for your comments. Boy, am I glad to have come across this site. I visited so many but stopped, read, and joined this club as soon as I saw membership and contents. This is such a nice support group especially for anxious patients like me who are about to have an implant.
1. Our health group is lucky to have a choice of pacemaker.
2. My cardiologist said that I have bradycardia with 3rd degree AV block - sinus brady, complete AVB, narrow QRS (I don’t know what all these mean yet).
3. My doctor had already recommended a dual chamber which I also prefer.
4. I will ask him about MRI compatible PM and blended sensor.
5. I’ll also ask about subpectoral placement because I play badminton and am on the light side for weight.
6. My doctor also stated that 90% of his patients go home after the surgery but I’ll ask for an overnight stay.
Again, thank you all. You have been very helpful. I’ll post results after surgery on Tuesday next week.
Chubs

Thank you again for comments

by CHUBS - 2014-06-11 12:06:36

Thank you for your comments.

I first consulted a cardiologist in 2011.

I went back last month with a log of my BP and heart rate.

There were times when my heart went down to 40s and even below 40 a few times.

From my naïve perspective from reading my diagnosis, it seems that I have both AV block and sinus Brady.

The important thing is what you said: Both will be fixed by the PM.

Thanks for the encouragement.

Cheers!

Chubs 6/10/14

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