Medtronic or Boston scientific

Getting a PM January 2nd for second degree AV block. EP nurse says he puts in Medtronic PM's. I'm not certain if he would put anything different in but am curious from you all what would be the best PM for a 40 year old who enjoys being active. Kayaking, jogging, etc... I have 4 young kids. 
 

thanks 

 

Philip 


12 Comments

It's the Settings that matter

by Swangirl - 2019-12-20 16:02:21

I don't think there will be a concensus on this site about the best brand of PM.  What I think will matter ultimately on your ability to maintain your activity is the settings and how skillful your EP will be in tweaking your device to get the results you want.  If you search on this site under "settings" you will learn a lot about what to ask for and how your device might work for you.  Your atria may be firing on it's own but with an AV block your ventricle will be paced more often.  It's going to be important that the ventricle keep pace and not just give you the lowest rate.  That's where rate response matters.  I am not scientific and my description is very primitive.  You are young and will be at this a long time so you need to educate yourself about how to get your device to work optimally for you.  

Which brand?

by Gotrhythm - 2019-12-20 16:42:52

Which pacemaker to implant is the surgeon's decision. Our opinion wouldn't really mean much.

However, although all pacemakers do fundamentally the same things, some do it a little differently. Some pacemakers are a better choice than others for people who pursue certain sports.

Something you might not have thought about is that you are not an average heart patient.  It's important that you have a talk with your surgeon before getting the pacemaker. Speak directly to him/her about your activity needs and. Don't assume that he/she knows just because it's in your records.

You are new at this pacemaker thing. It's good you're asking questions. It's smart to learn as much as you can, so that when you need to advocate for yourself, you know what's what.

Pacemaker Club is a good place to bring your questions.

Welcome aboard

 

Depends on what max HR you need, and if the make/model can deliver that for you

by crustyg - 2019-12-20 18:42:02

I agree with the above comments - it's the settings that matter, esp. if your SA node is working well, as the primary role of your PM will be to transfer the atrial electrical impulses down to your ventricles.  Up to a given limit any PM should be able to do that.  Question is, what maxHR you will want.  If you're vigorously athletic then you will probably need 170bpm, and that may be an issue in DDDx.  If you SCUBA dive, then you will want a box that can withstand 7bar, and not all can.

If you have SSS+brady+chronotropic incompetence then it's simpler - your variable HR has to come from the box and there's a clear difference between manufacturers.  But this isn't you.

A *really* important issue for you is to ask your EP doc if you can have a His-bundle ventricular lead.  The evidence seems to be increasingly compelling that long-term, right ventricular apical pacing is bad for most patients' LV function - and a His-bundle lead prevents that.

I don't entirely agree that the decision about manufacturer of PM should be down to your EP doc.  He/She may *prefer* to use one manufacturer rather than another (more familiar with the leads, the programming, only one vendor's programmer in a remote site or other, less honourable, reasons), but for them it's 45min versus 75min - for you it's 7-14years of the wrong box.  There are some *very* unhappy folk on this forum who have realised - far too late - that they've got the wrong PM implanted.

I agree with the above

by marylandpm - 2019-12-20 19:25:51

  I don’t know where you are located but I would go to someone who is doing hisbundle pacing.  Check it out and fine a EP who has been doing it. 

 

 

HIS pacing

by pbbrown7 - 2019-12-20 19:49:42

My HV interval is 62ms. So my AV node is blocking and my HIS is slow. So EP says no go on HIS. He wanted me to wait for the Micra AV which is the new leadless coming out late next year that supports AV block but can't wait that long also not sure I want something that new and untested. 
I want to kayak, and jog and maybe play basketball. I've been mowing with a rate of 90 for the past two years. So any rate above that will be gravy!! I have 2:1 AV block. 

?

by Pacer2019 - 2019-12-20 20:55:26

From what I see the Medtronic brand is overwhelming the one most used In the US while it's Boston Scientific in the UK.

Advocacy

by Keithwhelpley - 2019-12-20 22:16:48

Insist that your doctor tell you all the options and they fully understand how active you are. MAKE THEM LISTEN!. I made a terrible mistake by not asking about that. I too am very active and put in a St. Jude's  PM/ICD after an electrolyte imbalance. I didn't event know there were more sophisticated units and doctors never asked about my activity level. For 18 months I have been trying to figure out my own settings because I have only an accelerometerfor rate response -- nothing more. My cardiologists (8 in total) have all bee resistant to question the settings placed by original cardiologist. But it turns out I didn't need an accelerometer or a Rate Response turned on at all. 

In my case I didn't have chronotropic incompetence which is why a Rate Response is turned on. And having it turned on when you don't need it can create  huge problems. In me it led to pacemaker mediated tachycardias. Every doctor (Even a Mayo doc) after mplantation is reluctant to deviate fronm the original settings. That's why the doc needs to be clear and absolute about the settings.  I had to DEMAND doctors turn off my Rate Response after it was clear I din't have the condition that required one. It fixed the problem thanks to my own research and insistence. 

VERY IMPORTANT: Since you have time, make the doctor tell you NOW what settings he plans to have your pacemaker on and WHY, then research.

The American College of Cardiology has very specific conditions that require a PM and SETTINGS. 2nd degree Heart Block, I believe is one and there is a specific setting for that. The setting they propose should be for that. And if it goes against what you've read, then make them tell you why they are deviating from the American College of Cardiology. I found out after mine was implanted caused me problems that it was all about the settings. It most likely is always about the settings. Rather than figure out my problem they prescrived flecainide (a dangerous and powerful antiarrhythmic). 

Very few cardiologists and EPs know really how pacemakers work. They know how to put them in and generally what they are supposed to do. But they don't much about the settings, nor do the technicians. Pacemakers are GREAT devices that save lives. But doctors aren't trained like the engineers who design them. Doctors deal in vague symptoms and faulse positives and negatives. Engineers work in absolute mathematics. Each setting has a specific purpose. The fact I wansn't asked about my activity level and the doctors didn't give me options should have raised a flag aobut what they really know about the products available.

As a recipient, please educate yourself and demand answers. As you can tell, I have been very disappointed with every cardiologist and technician I have had. If it wasn't for my own research and locating a retired PM engineer who would talk to me, I would never have solved my problem. God knows my docs were happy to just prescribe me flecainide -- kicking the washing machine instead of fixing it. 

 

trust

by dwelch - 2019-12-21 11:47:13

find a doc you trust trust the doc you find.

You want the doc to pick the device, not you.  All the brands are good, no such thing as a better brand.  One might have a issue this year or one might have a cool feature, but the next year another may have an issue or cool feature.  we get these every 10 years give or take and they can switch brands each time, I have had metronic, st jude and boston sci. and three different brands of leads too.

YOUR job is to tell the doc/team making the decision what your actual lifestyle is, exercise, favorite sports, etc, and what you want to do once fixed by the pm, things you really will do not just think you will do.  That plus your condition helps them determine the device and settings.  The settings can change but the device wont until the next one.  

...

by SNORTINGDONKEY - 2019-12-22 12:39:16

Two thumbs up to Keithwhelpley's comments. I am a triathlete/endurance athlete and have now realized I got the wrong PM. My doc is recommending I go with the new Medtronic Micra Marvel 2 coming out hopefully next year.

You can have input

by Pacedmyruns - 2019-12-31 20:08:27

Those that are responding about maker doesn't matter is wrong. While all are about the same they all don't have the same bells and whistles. Boston is known for the best for athletes. I've seen people change devices to Boston for the Minute Ventilation and accelerometer they have. Medtronic has sleep mode and others don't. I asked by doctor about which one he uses and he specifically picked out Boston because I'm so active in sports. He said he can implant any of the brands but felt Boston had what I needed. So definitely ask. It's a permanent thing for years before you can change it out. 

It does matter

by Mike417 - 2020-01-15 17:49:29

I thought my EP Doc had listened to me and understood that at 66 I was very active hiking, backpacking, and speed walking.  But he really did not; he suggested the Medtronic Azure, and it was a nightmare of almost weekly visits to the EP lab trying to get my PM settings correct.  It would not recognize going up hill, upstairs, or wearing a backpack.  I became very knowledgeable about the PM,  and knew more that the nurses in some cases.  I finally convinced my doc that I could not live this way, and in late Dec. (one year) had it replaced with a Boston Scientific Accolade.  Big difference!  It now responds to my exercise - the MV sensor detects when I am breathing harder during a workout and increases my HR.

Be your own advocate!  Don't surrender control to the doctor - he is there to help you, not tell you how to live your life.

Mike

Medtronic

by pbbrown7 - 2020-01-17 20:00:24

Well I'm now two weeks post procedure and have a Medtronic azure DR. My AV node works fine so I don't need the minute ventilation of a Boston scientific. I havn't found anything that a Boston has that my Medtronic doesn't have that I need. I still have some trouble near 80bpm when my second degree heart block kicks in where I can tell that I am pacing and I have slight heavy breathing and feel like something is out of sync. Not sure if it's the AV delay or what. I had rate response on for the first week and it drove me crazy and had it turned off. I've had my heart rate up to 132 with my own SA driving. Just need to figure out what setting I need to tweak so that it's not as obvious when I go into block. Once I'm walking for about 5 min and my HR is up to around 105 I feel pretty good. At 105 I am SA sense and VA pacing. I mentioned to the doc about others saying Boston scientific but he kept saying Medtronic invented the pacemaker and it would meet my needs. I should only need something that can track my SA node and pace my ventricles during my 2:1 second degree blocks which start to happen when my rate gets closer to 100. Sometimes even in the upper 80's. Wasn't a problem in my 30's because it would only skip every 4th beat at a rate around 140bpm. Now I block at 100 and have a pulse of 50bpm and eventually hit a ceiling at 90 something in 2:1 block (well before the PM). My EP is known for perfecting PM surgery and is very smart and very nice. I just trusted him after asking him about the brands many times, even right before the surgery. Hope it was the right one. He wanted me to wait till the Micra AV that's coming out in late 2020 but my symptoms were too much and I couldn't wait. Plus they don't know what to do when the battery runs out of those new single chamber Micra devices. I'm so young that if you can only have 3 put in because they can't remove them. Yikes!! Maybe in 10 years they'll have it figured out and I can have these leads and PM removed and move to the new leadless pacemaker from Medtronic (Micra AV). I sure appreciate everyone's advice. Again since  I didn't need the respiratory rate response I didn't see any other reason to push my physician to put in a Boston scientific. Perhaps I'll end up being like Mike who posted before me and find out a setting the Boston had that I need but so far they seem similar. I just need something tweaked so that I feel better when this block first starts happening. I hate how it feels sometimes. Thanks

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