Pacemaker replacement

Replacement

by Good Dog - 2016-10-21 14:27:56

First of all, you get to choose the manufacturer unless your doctor tells you otherwise. If he does, you need to find another doctor. I understand that some doctors will standardize with only one manufacurer, but not always. My EP will implant whatever I ask for. Two of our larger local hospitals have PM clinics in which they have all of the equipment with which to do the checks for all of the various manufacturers.

You doctor is correct that an experienced surgeon "can" do the implant. However, you are served much better by an electrophysiologist. They are trained and generally much more experienced with PM implants. If I were you, I'd entrust my heart care only to an EP (if possible).

Remember, an EP is specially trained in heart rhythm issues.

Sincerely,

David

surgeons

by Tracey_E - 2016-10-21 15:34:27

If you don't need leads, anyone can do it. I had a general surgeon do 3 of my 5. And I only see the ep when it's time for a replacement. A regular cardiologist takes care of me the rest of the time. 

As for brand, have a discussion with your doctor about why he wants to change it and why you want to keep it the same. There is something to be said for having the one that your current doctor knows inside and out, since he's the one programming it. It may be that there is a feature you would benefit from on the one he suggests.

PAcemaker replacement

by Mary Anne - 2016-10-21 15:41:24

Thanks much. They made me feel like I was way out of line even asking for a referral to set up an appointment with an EP. 

EP more Skilled

by Figallegro - 2016-10-21 16:08:34

From what I have learned regading a major difference in using an EP surgeon, is there is less liklihood of infection using an EP.

PM features

by BillH - 2016-10-21 16:21:01

It isnot the brand, but the features that YOU need. PM are used to treat many different kinds of heart problems. Some conditions only require minimal PM features. Other condtitions need every feature to be twicked to the max to get good performance.

How well does you prescent PM work for you? If so ask for a model that has similar features, which may or may not be the same brand.

If not then you need to you need to see a EP for evaluation and selecting a new model.

The replacement (vs new) is only a minor part of the equation.

not simple, and not all EP's are created equally...

by Cabg Patch - 2016-10-21 18:48:11

First, I would not assume that an EP is superior to a CardioThoracic Surgeon  for replacement. What you are really interested in who has the most experience in SUCCESSFULLY implanting devices. As TraceyE said, she's used a surgeon for 3 of her changes and very happy. Rest assured I know at least one EP who has a reputation and does hundreds of implants and I wouldn't let hime observe much less do my surgery (again). Check with others in your area who have a device and see what they did and who they recommend.

As for what particular brand and or model, it depends on your needs and which device will work best for you, not which model a cardiologist prefers to keep everyone the same...in fact I'd be dropping that guy. Your needs could have changed since your first device and there may be other manufacturer's who make a model that will work better for you. Changing brands is no biggie, the leads are pretty much interchangeable.

Good luck  whatever you decide.

infection

by Tracey_E - 2016-10-22 09:29:05

On new implants, complication rates are lower when an ep does the surgery. (Somewhere, I bookmarked the study, will see if I can find it) Replacements are a different story, all they're doing is going in through the scar tissue, disconnecting the old box, connect the new one, test the leads, close. There is very little that can go wrong since the leads aren't involved. Infection rate is going to be about the same no matter who does it. Hospitals all have infection prevention protocols now. I was blown away at the difference in precautions when I had a replacement earlier this year vs my last one in 2010. Most of the precautions came from the hospital, not the surgeon. 

I'm not saying don't insist on an ep if that's what your comfortable with, just pointing out that it's not necessary. I've been a heart patient a lot longer than ep's have been a specialty. Once upon a time, there were cardiologists and cardio-thoracic surgeons. I've had the same cardiologist all this time and when I got my first pacer, he sent me to a cardiac surgeon. So while I get that ep's are more specialized and preferable, I haven't seen a reason to change from the practice I've been happy with for many years and they've taken excellent care of me.