Different Models of CRT-D Devices

  • by BarbD
  • 2018-09-20 14:02:11
  • ICDs
  • 995 views
  • 9 comments

How does the EP doctor decide which CRT-D device to use on a particular patient?  It looks like there are several manufacturers (Medtronic, Boston Scientific, St. Jude, ...?) and each manufacturer makes several models.  How do you know which one if the best one for you?  Are there specific ones that are better than others, or with better features I should be looking into?  Sorry - kind of overwhelmed here and trying to do some research.


9 Comments

the best

by Tracey_E - 2018-09-20 15:21:05

They are all good and the differences between them are minor so you can't really go wrong. You want the one your doctor knows inside out because he/she's the one who will be programming it. Most hospitals work primarily one or two manufacturers. Most doctors have one or two that they know best and use the most.

I'm not sure about CRT-D but with 2 lead pacers there are some differences in rate response, the feature that gets your rate up for you on exertion.

I'm on my 5th. The first was done as an emergency so I didn't have time or knowledge to ask questions, and the others I trusted them so didn't bother asking. Once my doctor went with a smaller one that would have a shorter battery life but would be more comfortable for me. With #4,  there was a feature that Medtronic had that St Judes did not so it was offered to me but I've had the same SJM rep since day one and he is amazing so I wasn't willing to start over with a new rep for that one thing. Turned out SJM added it, so now I still have SJM and #5 has it.

Medtronic is the largest and therefore has the most reps. Boston is the smallest. SJM (now Abbott) is between. There is also Sorin but I don't know if they make CRT-D. 

Trust your doctor to know more about this than you can google. It's ok to ask what the differences are and why they've chosen the one they have for you. I also learned early on that once they knew I wanted to understand, they were more liberal with the explanations. A lot of patients don't care to understand so they don't say much other than looks good, see you next time. Make it clear that's not you. 

That's why the EP's get paid the big bucks.

by Theknotguy - 2018-09-20 15:25:08

That's why the EP's get paid the big bucks.  They have to make the determination as to which pacemaker will work best for you.  Then there is the post implant tweaking to get it more refined for your needs.  So, in a sense, each pacemaker ends up being fine tuned for you personally.  

I've asked my EP several times as to what I have - heart block - what?  He's always been vague on the response as my situation doesn't always fit neatly into some of the diagnoses out there.  Frustrating, but as long as I'm OK, no complaint.  

The 93 year old guy I sit next to in church has a "generic" pacemaker.  It, in essence, just keeps his heart beating.  My pacemaker keeps my heart beating but it also runs two programs for afib.  So I've got a lot more going on than most.  We both have Medtronic.  So it isn't just the manufacturer.  Although some brands have features others don't.  Some brands are better for people who like to do bicycling.  

My EP has a lot of "generic" patients so he switches between St. Jude, Boston Scientific, and Medtronic.  That way, if there is a recall on any of the brands it only affects a smaller percentage of his patients.  

As to what and why an EP choses one brand over another, you'd have to ask them.  They got trained to read those squiggly lines and make sense of them.  I sure can't and I don't think I'd qualify for medical school so I could get the training to read them.  The doctor who implanted my Medtronic knew I was having  problems with afib and Medtronic had come out with programs for afib on one of their models.  That's why the EP chose Medtronic for me over another brand.  

I feel if you have a particular brand of pacemaker and it is working well for you - you will probably want to stay with that particular brand.  I'm prejudiced toward my Medtronic but I'd probably feel the same about Boston Scientific or St. Jude if I had one of those.  

I woke up in the hospital with my pacemaker already implanted.  So I didn't have to go through the pre-implant angst others have.  If you and your EP have time, you can discuss with him/her.  Hopefully it will make you feel better about what you'll be getting.  

Hope your implant goes well and you have a good recovery.  
 

decisions

by ROBO Pop - 2018-09-20 15:54:24

The way it works with my EP, and all the ones I'm familiar with locally, is that every manufacturer has a rep (the ones I know are actually engineers) who is integral to his practice. Bear in mind they float from EP to EP on different days. Anyway the EP reviews the patient issues with all the manufacturer's and they jointly decide which is the best device for you. If there is no clear cut choice then whoever is next in line gets the sale. That Rep is then present during implant in the Cath lab and does the set-up and programming, as well as interrogations after (in most cases). While the EP is knowledgable, it's the Reps who are the experts on these devices and programming and make the decisions. The Rep definitely does the programming etc but only with approval of the EP by law. 

Let your EP make the decision, if you have to ask you definitely don't have the expertise to make the best choice for your needs. 

Thanks

by BarbD - 2018-09-20 20:41:40

Ok - thanks for the replies. I guess I should just trust my doc to make the right decision. I think I'm trying to get some control over what seems like an uncontrollable situation to me.  I'm just so anxious that my mind is all over the place. Theknotguy - you mentioned about devices being recalled. How often does that happen??  They would have to remove the device and put another one in? :-(

Recall

by AgentX86 - 2018-09-20 22:36:40

It would be very unusual to have to replace a pacemaker due to a bug (or "feechur" as hardware engineers call "bugs"). Almost anything can be fixed by a software update, or a problematic option can simply be turned off.

These recalls are unusual anyway and you can find them with a web search, if you're interested in seeing the sorts of problems found and the frequency and severity of the symptoms. Pacemakers are incredibly reliable and bug-free, as such things go.

More questions

by BarbD - 2018-09-21 16:25:24

If the EP uses devices/models he is most familiar with, does that limit which hospital/doctor you can use for ongoing evaluation/interrogation,progamming your device?  For ex., if I have the device implanted by EP in 1 hospital, can I still see an EP to take care of me in another hospital?

Tracey_E:  Does each patient get their own rep for their particular device?

 

 

Lifestyle is important too...

by BOBTHOM - 2018-09-22 00:11:40

Make sure your EP knows about your lifestyle.  If your into running, weight lifting, etc.  That will help him choose the device that has the options that will benefit you the most.

reps

by Tracey_E - 2018-09-23 09:57:44

There are two manufacturers reps for St Judes in my area. I've been to several different doctors but still see the same two reps. The reps typically have clinic days for each doctor in the area, like mine was second Tuesday of the month. They would be there for surgery and were called in if there was a problem between appointments. Some offices have the rep come in to do the checks, some offices have a nurse that does it, some ep's do it themselves. I switched to an adult congenital ep a couple of years ago. When I go to his main office (90 min trip), he and his NP do the check themselves. When I see him in the smaller satellite office (10 min trip), the SJM rep comes in to do the checks. 

Most hospitals can deal with any of the devices. They have relationships with all of the companies. Doctors can also deal with any of them. Publix is my favorite grocery story, but I also shop at Whole Foods and Trader Joes. Whatever device you get, you won't be limited to that doctor or hospital. 
 

A note about the settings, getting them fine tuned happens only when we first get it. Some are fine with the settings they send us home with, some take a few tries to get it adjusted, but after that we can go years and they don't need to mess with the settings again. 

its not your problem to solve.

by dwelch - 2018-09-28 04:53:45

its the doctors problem to pick the device not yours.  Find a doc you trust and trust the doc you found.  Your job is to educate that doc on your activites you do now and/or would like to do with a pacemaker that you may or may not be able to do now.  Thats your job.  Let them pick the device.

As far as reps and which doc you see, etc.  Its not unlike having a filling in a tooth, you dont have to see that dentist for the rest of your life.  I have had to switch docs for stupid insurance reasons, have moved a few times over the last 30 years with pacemakers so changed docs.  Did "fire" one I didnt like/trust by simply calling another one and seeing them.  My first three docs did the surgeries and the office visits.  The practice I go to now my EP does not do the surgery they have someone that is a top notch surgeon another that is I dont know what a cardiologist certainly, but my EP does the office visits and deals with the programming and maintenance. YMMV, and dont worry about having a one doc deal or many.  I was already out the first time with this surgeon, I insisted on meeting him before the second one he did simply because I wanted to, would be nice to meet him, so they arranged that.  Trust him as much as my EP.

There are very few brands and the brands are buying/merging with each other so you will find that they only need to keep a couple/few programmers in the office with the brands being managed by the same parent companies.  TraceyE pretty much covered this.  Now there may be countries that you visit that are a different story, my folks lived in Saudi for a while (oil business) and I could visit them while still a teen and early twenties.  Went to the doc while there and my brand was blacklisted in the country, and my rate on the ekg was below my minimum but I was literally three weeks post op.  and back then it took a good part of that first year to dial in this pacer. they offered an emergency exit visa, but I just finished out my visit and saw the doc when I returned to the states.  beyond that I have not had any worries about being treatable.  The pacers are so much better now they do so much more dont need to be manually tuned as much as before.  And once you are dialed in they can put a new one in, even from a different brand, and use the same settings and not need to make new adjustments.

I have had medtronic, st jude and currently a boston scientific pacemaker, have medtronic, guidant and boston scientific active leads (have a broken medtronic in there as well) the boston scientific did require a tweak, the others did not after that first year, and I dont expect new patients today to need much tweaking after the first visit or two.   They have you in a few weeks or so after then may be 6 months and then you start the annual visits in those first one or two visits they should have it dialed in.  

Reps are really no different than the folks that supply napkins and napkin holders to a restaurant chain.  Not with respect to schooling or other skills but in that they are employees or hired by the provider of that product and are there to help you (in this case the doctor) choose the product and use it.  Bob might be the one that is sent out for your surgery and if there is a reason at all to send a tech out for you again between surgeries maybe they send Ted out the next time.  And there is no reason for you to worry about that any more than if one nurse does your first interrogation and a different one your second.  Depends on where you live and how many reps there are and what their coverage area is. 

Some folks on this site say the rep does all their interrogations.  In my 30 year experience the reps are at the sugery and in one case I had a rep deal with this boston scientific tuning, other than that no reps.  So 30 years 6 encounters (with me, the doc of course very often) I know of with a rep of which lets say three I was awake enough to actually meet.  And maybe only two of those were the same person...maybe...

Back to your original question.  The batteries in the devices aim for say 10 years give or take, so with the first one and each one that follows your job is again to tell the doc what your activities are or you want them to be so the doc can if needed use that to choose the next device, your medical condition of course is the initial driver but there maybe some other choices beyond that based on your requests. Or the doc may discourage you from doing those things if it is not compatible with your condition.  Between implants your job is to tell the doc how you are feeling, I struggle with stairs but am okay otherwise, there may be an adustment they can make.  If you dont tell them anything though you get what you get...

 

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But I think it will make me feel a lot better. My stamina to walk is already better, even right after surgery. They had me walk all around the floor before they would release me. I did so without being exhausted and winded the way I had been.