A Survey

define what you mean by optimizations

by dwelch - 2018-12-25 01:51:30

Not sure I understand the question.  What do you mean by optimizations?

optimizations

by Dave H - 2018-12-25 12:46:17

PM optimization:  Sonographer at the echo screen, Doc (usually an EP) standing behind the sonographer and watching the screen. Device Clinic nurse nearby with her "mouse" hung over the patient's shoulder and "reading" the patient's PM.   Doc, watching the Echo display, decides he wants the left (or right) ventricle to "fire," say 20ms sooner, or 15ms later, or whatever and instructs the device nurse to change the PM timing. Docs aim is to get the most out of every contraction of both the right and left ventricles. Of course, one needs a Doc who can really "read" an echo. My previous heart failure Docs' specialty was "echocardiography" - a specialty that is rare. If one is fortunate, a talented sonographer is almost as valuable as the Doc. The optimization I had a couple years ago began, then after around 20 minutes of instruction from the Doc to the device nurse, both the Doc AND Sonographer shouted, "ALL RIGHT!!!"  Did I notice any improvement in my abilities regarding exercise and such?  A PROFOUND YES!!!

Obviously, pacemaker optimization is either not widely known or not spoken of on this site.

--Dave--

Device Settings Changes

by KonaLawrence - 2018-12-26 02:29:30

Aloha ,

I've not had any input to Pacemaker settings from anyone except the Device Clinic Nurse and the Medtronics Technician.  All the cardiologists and EPs I've talked to do not have anything to do with device settings.  If you're interested in my experience, you can look at my posts about settings.  Here's one titled "Athlete PM Issues"  which is the 2nd message in this thread...

https://www.pacemakerclub.com/message/33955

Good Luck

Device Settings

by Dave H - 2018-12-26 11:36:42

Hey , Kona:

I'm surprised at the number of folks who have been shown  there is nothing to do but implant the PM, turn whatever controls its settings "on," and that's that for that!  An echo watched by a talented Doc. will reveal how the heart is functioning.  My former Doc was an Ace at doing this task and I've been to the Mayo Clinic in Rochester, MN where they also perform this task. It just may be worth looking into.

Mele Kalikimaka!

--Dave--

BTW: Not a Xmas tune but a great tune in it's own right:   https://www.youtube.com/watch?v=XnsEDlNkqc0

not like that

by dwelch - 2018-12-26 22:53:56

I have had adjustmenst over time, they cant just leave you on one set of settings.  am on device number 5 over 30 years into this journey.  

googled what you were asking about, sounds interesting and expensive, cant see this happening to everyone anytime soon if ever, maybe special cases.  I would also be careful assuming the tuning they made on you couldnt or wouldnt have been done through normal/typical avenues and you would still be feeling better and or might not be feeling better with these settings because they didnt use cool tech to do it. 

We change over time so the settings have to adapt and thats part of the annual checkup and we get a new opportunity to go through all of this again with each new device we get.  the tech for each device is different from the last, had a negative effect on mine, good thing there were some safety checks in the firmware, had feedback from the ventricals to the a lead that thought it was another body paced beat.  Basically a pacemaker induced PVC.  firmware stops that at two or three otherwise I would have been done for.  They fixed the setting, found the problem by examing holter data, would never have found it with sonography, insurance could have bought me a house or two for the kind of money that would have burned through...a holter was the right tech for the problem/adjustment.  Add the doc that spent her weekend going through every single heart beat as I had never complained before so she knew that with my decades of experience there was something wrong.  and she found it. called me in the next day.  pacer tech showed up to make the adjustment.  I get belly bumps from having a three lead device from time to time, but I find that more entertaining than a problem.  no reason to mess with the heart to adjust for that.

Were you part of a research experiment?  While it can help tune/optimize, I dont see insurance companies nor practices spending that kind of money.  Maybe some atheletes can travel to some list of facilities for an optimization.  And note that we change over time so it can go out of optimization before the devices battery is done.  And not to be insenstive but most folks with pacers dont need an optimization.  More and more younger folks are getting them sure and they would benefit, but others are not running marathons, they just need to get around and do normal basic stuff and wouldnt notice the difference.   I would assume even if you add a treadmill which a number of the echo machines are next to, they wouldnt necessarily be able to tune the rate response in a short enough session to be affordable.  And that is as important as the other settings if you are trying to optimize for an active person. 

Did they do this for all of your devices?  How much longer do you have on the current one?  How often do they do this optimization on you?

I am also curious to see who has done this, what countries and towns and practices, research facility or not.  teaching hospital or not. (is there such a thing as a non-teaching hospital I wonder?).  

Device Settings

by Dave H - 2018-12-27 11:44:23

My optimization was performed at BS&White, Temple, TX sometime in the summer of 2016 by Allan Anderson FACC, FAHA and a Healthgrades Honor Roll member. (He has since retired). Procedure took less than an hour. Medicare and my supplement paid for it all. As I said, I was lucky ------ I had a Doc and a sonographer who could actually "READ" an echo image. That PM was replaced (low batt) a few weeks ago. I am planning for an optimization with my current EP (who has the same credentials as Dr. Anderson had)  for sometime in the near future.  BTW: If one allows a Doc without these credentials to treat you, one is asking for big trouble. What makes me say that? - Experience!  And I'll stress this fact again and again:YOU NEED A DOC WHO CAN ACTUALLY READ AN ECHO. Why? interpreting an echo is mostly subjective.

Check here: https://www.ncbi.nlm.nih.gov/books/NBK2215/

--Dave--