New Member with a couple of questions

Hi Everyone!

So glad to find this site. My EP says that she wants me to get a pacemaker as soon as I can qualify (Medicare). Background: I have Afib and take both an antiarrhythmic medication (flecainide) and a beta blocker (propranolol). I am not a good candidate for an ablation due to other health issues, so medication is the preferred treatment approach. 

At the moment, with these medications, my resting HR is 41-42 at night and about 47 during the day when active. I am unable to get my HR up enough to support much exertion (due to the medications) so I huff and puff even when walking. Should I get breakthrough Afib and need to raise my doses, I wouldn't be able to do so as my HR is already so low. 

My question is about qualifying through Medicare. As I understand from my EP, I need to demonstrate on a treadmill stress test that I am unable to reach 75% of my target HR for my age. I am to take flecainide for the test but drop propranolol for a couple of days before. I believe that the other way to qualify is to have a documented pause of a few seconds (5?). I have had one pause but it was only documented on a HR monitor, not an EKG. I have a treadmill stress test scheduled.

Is the above your understanding of how to qualify? My EP would like to use the latest St. Jude's that was just approved in Febuary. It is MRI safe, will try to pace your through PACs and I think it is called the Assurity MRI. Has anyone had this model implanted, and if so, do you like it?

I have been reading and searching here since my EP proposed a pacemaker and really appreciate this community. Thanks for any information


3 Comments

Medicare coverage

by TBrous&Chip - 2017-07-27 07:35:35

Google search: pacemaker ncd

Will show the Medicare national coverage determination (ncd) information.  This lists covered and non covered indicators for pm coverage

Medicare

by The real Patch - 2017-07-27 13:35:55

Your EP should be well versed in what criteria you need to meet for Medicare, as he most assuredly deals with that issue constantly, however if you want to see, go to the Medicare web site. If memory serves, your resting hearg rate alone should qualify you but?

I've had St. Jude's (Now Abbott Laboratories) hardware for years now and am on my 3rd unit, a CRT-D. Suffice to say I strongly recommend Medtronics pacemakers.

 

Medicare coverage

by Going Forward - 2017-07-27 16:54:20

Thanks for your comments. I had looked at the Medicare site and was confused by this: "The following indications are non-covered for implanted permanent single chamber or dual chamber cardiac pacemakers: 1. Reversible causes of bradycardia such as electrolyte abnormalities, medications or drugs, and hypothermia."

I know of many Afib patients who have pacemakers due to their medications lowering their HR into bradycardia, so I was wondering how they had qualified. I'm sure my EP has experience qualifying her patients but I was interested to hear from other patients on Medicare who are taking medications that lower their heart rates, yet who have qualified. I'll certainly ask my EP about this clause at my next appointment, but that isn't for a few months and I like to go to appointment with the appropriate questions.

The real Patch, may I ask why you prefer Medtronic over St. Jude? I have read of some St. Jude recalls but, from what I found, the problems seemed to be resolved when Abbott took over. I think my EP likes this latest St. Jude's model due to its feature of trying to pace you through PACs--as they often lead to an Afib episode. Perhaps there is a Medtronic device that has the same feature?

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