Pacemaker Replacement with existing Lead

Leading questions

by The real Patch - 2018-04-13 18:22:14

There is a lot of interchangability with leads between manufacturer's. You Dr will have a book that tells what devices your lead will work with. 

old lead

by zawodniak2 - 2018-04-13 18:39:12

Your original lead may not be MRI compatible.  You should pose this to your doctor.

                          Rodger

Old lead

by Sui - 2018-04-13 19:01:56

Yes, the doc has already told me the lead is not an MRI issue, though what research I've been able to do so far does not specify if that lead is compatible with the 3Tesla and the 1.5Tesla. My question is whether or not my lead is compatible with Medtronic or St. Jude devices. I had hoped, and still do, to find some guidance here or else my doc has given me an assignment i can not do in his and my desire to be fully informed in a shared decision. I'll keep checking potential sources. Thus far i'm inclined to believe that one pacemaker vendor is not much help in dealing with the issue of a another vendor's product compatibility. 

leads

by Tracey_E - 2018-04-14 11:24:21

I believe they are all interchangeable. I have older leads (one is from 1994) and have a converter to connect it to the device because they don't connect now the way they used to. But they can make it work.

The lines are getting blurred between mri and non-mri devices. If you look for posts from pacerrep, he posted recently about an upcoming change that all devices will be considered mri safe. There are more and more hospitals that can safely do mri's on non-mri devices and leads so it's becoming less important.

SUI

by IAN MC - 2018-04-14 13:07:40

I have found exactly the same as you that individual pacemaker manufacturers are of no help whatsoever if you want to put a different make of box on existing leads.

I have a Medtronic with MRI compatible leads and want it changing for a Boston Scientific box next time but I want to keep the existing leads.

My cardiologist is very reluctant  because  " there is no published evidence that it is safe to do it  "

I asked Medtronic and, not surprisingly, they were of no help .   I would be very interested to know if anyone on here has had it done ??

Ian

relax...

by dwelch - 2018-04-16 02:46:52

Like TraceyE I am on pacer number five.  My first two leads, medtronic, 1987, one broke on first pacer replacement in 1994 with a guidant.  Broken one still in there capped.  Last year third lead for a three lead pacer, boston sci.   Three medtronic pacers, one st jude and one boston scientific, thus far, could very well see 4 or 5 more depending on how long I last.

If your doctor and the rep from the pacer vendor doesnt know what goes with what, their malpractice insurance had better be paid up and you should find a new doc now before the replacement.

In no way shape or form is it your responsibility nor problem to worry about if the leads fit, they should not give you any options of pacers they cant use, and/or they should make it clear (and you should simply ask) if you need a new lead to go with the new pacer and or as TraceyE commented an adapter.

Lead compatibility is NOT your problem if they are making it your problem find another doctor immediately.

You should be figuring out how things work, the pacer vendors are not going to give you ammo to sue them.  I am suprised they give us any information whatsoever or even answer the phone/email.  They are going to give, not sure, cant guarantee, etc.  Type answers, we have sued each other into this way of life.

MRI compliant is a separate topic, patients and their docs (read around this site) have a wide range of opinions on the topic, as with the pacers the MRI machines have evolved over time, so which device didnt get ripped out of which patient on some particular day could be by design or dumb luck.  Even if you know very little about the industry, it should still be obvious that just because one tech on one machine can manage to run it safely for pacer patients, doesnt mean that now every tech on every different machine across the planet has the same skills.  They simply do not.  Different tech, same machine, same hospital, you get what you get...YOU decide how badly you need that MRI.

The doc and the rep(s) had better know what they are doing, and you really need to trust your doc, not just with this decision, but settings, surgical skills, etc.  They should have given you a multiple choice question, a short list of possibilities, perhaps some pros and cons, but for whatever your condition is there shouldnt really be a long list.  If you have only one lead now you really dont need any of the four lead devices with an ICD, huge battery, etc.  You want/need one that is suited for your condition.  Just like not every model one vehicle manufacture produces will suit every need, the list starts to get really short down to one maybe two depending on the requirements/need.

Botton line though, just relax, anxiety is our biggest problem as pacer patients.  The mental more than the physical.  You are not their first patient, you are not their last patient, this is what they do, let them go do it.  If they are not asking you questions about leads, that is a good thing, one less thing to worry about, so dont. Rest assured if they get in there the lead doesnt work the rep has a new lead ready to go, they will simply put a new one in.  This is not their first rodeo. 

Now saying all of that, currently boston scientific has a bug that shows up more with medtronic and other non boston scientific leads.  Not a reason to avoid boston scientific all brands have and will have issues over time.  If you go with boston scientific make sure you have the right firmware.  Last year St Jude's got in trouble and had a recall, maybe it was the year before, but was not long ago.  Most of that was the feds made them a scapegoat for the industry (something technically they St. Judes cannot actually solve).  So perhaps its medtronics turn next to have a recall, who knows?  Nobody.  Nobody can predict these things, cant predict battery life, etc.  You get what you get, and be happy that you have it rather than not having it.  Not having a pacer when you need one is a far bigger gamble and much more worrysome than having one or not choosing the perfect one.

So leads: forget about it.  MRI you get what you get, what is the tradeoff between how much it can take vs what you give up to get that feature, you probably want to aim somewhere in the middle.  Battery life, most likely meas a bigger device, more  of a bump to bump into things with, and they cant really predict battery life, you get what you get, perhaps aim for somewhere in the middle...etc.  Brands, no one brand is better or worse than another (although if your doc/surgeon/practice prefer one or have more experience with one, go with that brand, you dont want to be the special case or any kind of an experiment).

Follow up to dwelch

by Sui - 2018-04-16 11:04:23

dwelch:

Thank you for taking time to provide such a lengthy response to my inquiry.  Your was comprehensive indeed!

A couple of comments for clarification:

1) My doctor has not left the decision to me as to which pacemaker is used to replace the Sorin.  It is just that he knows that I am generally inquisitive but more importantly he believes in an informed decision. Thus, he suggested I research the various pacmakers and their features.I would have done that anyway.  I am confident he knew at the time which HE would choose as a replacement.

2) When he informed me that the existing single lead (Setrox S 60) would remain, it never occurred to me at the time as to whether or not that specific lead was compatible with all pacemakers or not.  It was only after reading on-line, including here, that the compatibility issue popped up in two ways: 1) Does my existing lead determine which pacemakers are options or are all leads compatible with all pacemakers 2) Does my existing lead determine whether or not I can have a 1.5 or a 3.0T (Tesla) MRI of the prostate?  Clearly, a 3T is preferable but it is a very powerful machine.

3) I have every confidence in my cardiologist and frankly appreciate his desire for an informed and, theoretically at least, joint decision.

4) I came to this site of similarly-situated individuals seeking some guidance and am grateful for the responses.  When I sought to research both compatibility issues (device and MRI capacity) WITH respective manufacturers of PMs most especially including my existing Sorin (which is no longer used in the US), I got virtually no help...which made me even more inquisitive, frankly.  Apparently, no one wants to assume the implied liability in providing this information.

5) Generally, the response here seems to suggest that most if not all leads are compatible with most if not all of today's pacemakers. There have been no responses regarding the use of the newest high resolution (3Tesla) MRI machines as to whether the pacemaker device OR the lead is compatible.  I do know the 1.5 Tesla is used with many providers and I have been told that Medtronic makes a device that can use the 3T machine. What I DON'T know in each instance is whether or not my Setrox lead will narrow the choices and/or whether or not the device my doc (and me) chooses will be 3T compliant.  Again, he knows I'm sure but in my quest for an informed decision I would like to know as well.  

I hope this helps clarify my inquiry. I apologize to all for not making it clear the first time around....and hope this one is better.

Regards,

Sui Generes