EP vs Pacemaker Tech

EP and Pacemaker technicians

by Gemita - 2020-06-28 13:37:42

Hello Shanaber,

Although my EP's technician would be perfectly able to make setting adjustments without guidance from my EP, he will only do so AFTER I have seen my EP for review and AFTER my EP has given clear instructions for any setting changes to be made.  

In fact when I go to have a pacemaker check, the technicians generally only check to see whether battery and leads are still sound, whether any "events" are recorded like Ventricular Tachycardia or very fast heart rates, or % time I spend having arrhythmias, % time I am atrial/ventricular paced and important details like these.  They then pass this info on to my EP in readiness for any follow up appointment I have with him, so that he will know how my pacemaker (and I) are functioning.  

I usually ask the technicians lots of questions, or ask for a summary copy of my pacemaker check results.  Sometimes they don't like to give me this info the same day and I will then need to officially request it as part of my right to have access to my medical records.  It can be a slow slow process but well worth the wait to have this detailed data.

So yes, in my experience, you see EP first to discuss any problems you might be getting, then discuss any possible pacemaker changes to improve your symptoms, then you visit the technician for the changes.  I am in the UK. 

Different experience

by AgentX86 - 2020-06-28 16:57:31

The device techs I've gone to will make changes without EP prior knowledge, particlarly changes to rate response and such things.  Max/min rates, no, they'd consult with an EP first.  The device tech did put me on the day/night rates, though, before consulting with the EP. 

After any device check, either remote or in person, an EP gets a copy of the report for sign-off (and a copy is sent to my insurance company for payment ;-).  '

I see a device tech every three months but my EP only once a year, so the device techs have a lot of latitude on minor tuning things between EP visits.

tech vs doc

by Tracey_E - 2020-06-28 19:49:06

Technically settings are a prescription and the doctor has to authorize all changes.

Practially, the tech will make small tweaks then tell the doc, or if it's a big one go grab the doc for permission.

At my current ep, both will be in the room at the same time. My previous ep did the adjustments himself. The cardiologist I saw before that just did what the rep suggested. The rep knew way more about the device than the cardiologist. Incidentally, I've had the same rep through all of these doctors. He knows me and my lifestyle and my challenges.

tech vs doc

by AgentX86 - 2020-06-28 20:24:03

That's the theory but as you point out, the tech knows more about the hardware and what's possible than the EP.  My EP and usual device tech are 50mi apart and I doubt have even met each other.  The device tech is supported by a loal EP who I first used four years ago but haven't seen since I started down the ablation path (she doesn't do surgery).  I was passed off from her to an EP in a large teaching hospital and I still see him (once a year).  They're in the same hospital system so the records do get passed back and forth (with my cardiologist making sure everyone plays nice together).

I've never had my EP in the same room as a device tech, though he will send orders for any significant changes to a tech in the hospital, where I'll go to have them made.  Any small changes, like RR tweaks or sleep times are between me and the local device tech.

Different experiences...

by CyborgMike - 2020-06-28 23:07:37

Shana, as Tracey points out, any change to the PM is a prescription, so it technically needs doctors approval. That said, I have had a number of different experiences. I see you are in OC, so I'll use some specifics.

I started off with a Cardiologist and EP in South OC. Some of the best in the county, but my heart condition was rare and they couldn't diagnos it, so I was sent to Scripps in La Jolla. At Scripps I have a cardiologist and I've me the EP only once that put in my PM. In the weeks following my implant, I primarily dealt with my cardiologist. Sometimes he made the adjustments, but most of the time he sent in a tech.

A month later, I went back to my EP in OC, because he was my original EP. He is very good and incredibly smart, but his tech was a lady that (tries) to handle all variety of PMs. They wanted to make some changes, but she bumbled around for an hour, was on the phone with a St Jude rep three times, and ultimately, screwed up the settings. This was in a very reputable office connected to one of the top hospitals in OC, but it felt like getting your car worked on at a gas station vs. at the dealer.

In contrast, I now have all my settings and monitoring done by Scripps. The techs are always St Jude reps, since the volume is so high there. The monitoring staff and the techs seem 10X more informed and empowered than the OC EP's office I was seeing and easy to get an appointment. They implant over 3,000 a year at Scripps, so they have a much better system to support it. My OC EP is much harder to get an appointment and much harder to make changes. 

So, the moral of my story is it depends. Each office is going to be different.

It depends on which country ( and which hospital ) you're in .

by IAN MC - 2020-06-29 12:53:57

Like Gemita, I am in the UK but my experience is totally different to her's.

I have had countless PM adjustments done by my "tech" over the years , all with pretty much zero involvement from my E.P.

It is worth stating though that "techs" vary from country to country. In the U.K. they are all educated to science degree level , have had extensive training in every make of PM / ICD and are officially known as " Cardiac Physiologists " . They are considered to be valuable members of their cardiologist's team .

In some countries,  techs are PM company reps I believe .......which must colour their objectivity somewhat ......  I doubt that a rep for Brand X would  EVER recommend  Brand Y even if it would be better for the patient.

I assume that my tech notifies the EP of any settings changes which he makes. The system has worked very well for me so far

Ian

rep in the US

by Tracey_E - 2020-06-29 15:43:10

They are employees of the manufacturer so nope, they are not going to be recommending another brand! They vary in experience and education. The one I've had since day one has a degree in biomedical engineering but I know that's not the norm. 

Reps

by AgentX86 - 2020-06-29 21:45:07

PM techs or reps don't recommend PMs.  When you see the PM tech, you already have the PM. 

The techs I see are eployees of the hospital, not the PM manufacturer.  I saw the Medtronic rep when I first got my PM but haven't seen one again.  The techs will occaisionally call the manufacturer's rep to ask a question (couldn't get the clock changed once) .

my experience

by dwelch - 2020-06-30 10:29:54

I dont believe my techs as I call them possibly nurses work for the pacer company they work for that office.  I could be wrong, as I have had actual techs from the pacer vendor come in and show the nurse, ep, etc what they are doing.

In my docs current setup, the nurse/tech has some guidelines, take this measurement add this amount and change this setting to that number, and that happens every so often.  So it is a doctor prescribed setting change.  Have not needed other regular changes since my first device when there was no nurse or tech, my doctor was the only person in the room, did the ekg, ran the laptop, did the surgery, the whole deal.  My current EP does not do the surgery there is another doc or two for that, doesnt run the machines there are techs/nurses for that.  I would rather have the echo person running the echo, than the doc.  The doc can read/hear the results and the person trained and practiced at running whatever machine runs whatever machine.  Would rather have a nurse give me a shot than a doc.  But yes the doc is the responsible party for what happens.

My experience has always been you make the appointment with the doctor.  the test happens then you talk to the doc, whether the doc does the test or not.  if they were to change that and I didnt see the doc then I would have an issue with that and either future visits would be fixed or I would find a new doc.  So far no problem.  My doc knows that I know more about how the devices work than she does or any one in the office, and I know she knows her job way better than I do, and has lots mroe experience there, I trust her to do her thing.  Find a doc you trust trust the doc you find.

Some places leave you hooked up the whole time in case the doc wants to make a change, sometimes they dont.  Once you are dialed in there should be minimal need for changes, other than perhaps a tweak to save battery or whatever.  A lot of how this operates has to do with location, how that particular office works, insurance, etc.  So even in the same country, state, and city two of us can have different experiences.  So our answers and experiences will vary.  At the end of the day there should be a periodic test taken and that there is a doc that looks at it, it would make little sense to have someone not responsible make changes without directions from (as a poilicy or a response to something seen during the test) so one would hope a doc is present or nearby.

You are not here to make your docs feel better if you dont like the docs and or how that office works, find another.