Pacemakers

choosing a device

by Tracey_E - 2020-10-27 17:30:16

Most hospitals have contracts with more than one manufacturer and most doctors implant more than one brand, but usually they will have their favorites. It's a discussion to have with your doctor. Some include us in the discussion, some do not. Most of them will talk to us once they realize we have an opinion. Itr's ok to ask what they are choosing for you and why. You want the one your doctor knows inside and out, as they are only as good as the programming.

They always give us the latest and greatest. There aren't actually that many out there to choose from and it's not like iPhones where they make a new one every ten minutes. They can go years without making major changes.

They all come with an expiration date after which they are not allowed to be used on humans in the US so you'll always get a new, fresh one. 

CRT

by AgentX86 - 2020-10-27 21:41:34

Can you choose?  Probably not.  You can suggest but it's unlikely that anyone will listen.  A better plan, and highly recommended, is to discuss with your EP the sorts of activities you're interested in and what you expect to be able to do after.  Some are better for some activities than others.  The hospital may well have a contract with a single manufacturer.  If they implant enough of one manufacturer's PM, they may have a factory rep on-site to do the interrogations or perhaps as a expert source helping with the difficult cases.

You really can't tell if you're getting the "latest model" (they aren't cars).  Your doctor will choose the one most appropriate for you.  Which pacemaker is best for your situation is your doctor's job.

You can certainly ask but your only alternative is to find another EP and/or hospital.

incentives

by koala - 2020-10-28 03:00:57

Hi, I'm on the same boat - just decided to have a pacemaker. I was wondering about the same thing too.

I just read this article this morning. It is about what happened in Australia, but it might be happening worldwide: https://www.abc.net.au/news/2018-07-03/pacemaker-secret-payments-helping-private-hospital-profits/9923964

Since I will be going to the local public hospital, I guess I'd have no say in which pacemaker they'll install. It seems that they are mostly similar except some can tolerate MRI and some can't.

There seem to be a tiny pacemaker with no leads, which seems to be awesome, but it can only replace the single lead PM. Chinese scientists experimented with a batteryless PM, but that seems to be in experimental stage, a long way from human application yet. Then it's either with or without radio control (bluetooth?) that allows it to be reprogrammed wirelessly / remotely. 

Incentives

by AgentX86 - 2020-10-28 18:11:46

I don't think any non-MRI compliant pacemakers have been made in the last decade. There are problems with old leads but the pacemakers themselves are all mri compliant.

The differences are mostly in the way rate response is handled and only matters if you're a cyclists or swimmer (or similar). Another difference is the pressure rating, which only matters to SCUBA divers. If you don't need rate response or are a swimmer, diver ,or cyclist,it probably doesn't matter to you.

Yes, some pacemakers use Bluetooth to communicate but they CANNOT be programmed via Bluetooth. The security issues are too scary to think about. Bluetooth is used to communicate with a bedside box (or cell phone) to report the pacemaker's state to your doctors on some interval.

MRI compliant pacemakers

by Bob999 - 2020-10-28 23:35:35

My understanding is that non-MRI compliant pacemakers are still being manufactured and implanted.  I base that on current pacemakers listed on manufacturer web sites like Medtronic and Boston Scientific.

My further understand is that in the US the insurance company is a player in the decision making for pacemaker selection.  All insurance companies require "midical necessity" for coverage and there are specific features that may fall in the grey area.

MRI compliant

by AgentX86 - 2020-10-29 00:07:07

I certainly haven't seen a modern pacemaker that isn't MRI compliant.  If you have an example, I'd like to see it.

There are certainly guidelines (ACC/AHA/NASPE) that direct EPs and insurance companies are going to reinforce those guidelines.  There is a matrix (can't find it now) that shows what mode is used for each diagosis. One pacemaker can be used for multiple modes. This has nothing to do with the brand.

Note that the surgery itself is a major part of the cost and that's pretty much the same no matter which pacemaker is implanted.

MRI compliant

by Tracey_E - 2020-10-29 10:48:11

They may not necessarily be labeled MRI compliant, but MRI's can safely be done on all newer pacers. You might have to jump through some hoops to have it done and not every facility will be willing or equipped to do it, but it can be done as long as the leads and box are less than 10 years old. Even if you have one that is MRI compliant, you can't go just anywhere and have an MRI, there are still certain facilities you'd have to use and steps you have to take. Bottom line, people with newer pacers are no longer forbidden from having MRI's. Me, my leads are 25+ years old, no one will touch me. But those of you who have newer devices have options if you need an MRI. 

not your job

by dwelch - 2020-10-30 02:00:51

They pick the pacemaker, you dont want to have anything to do with it.  That is their job, this is part of their job and they do it on a regular basis, it would take you years at least to get the experience.

What YOUR job is, is to tell them what activities you currently participate in, that you really participate in not just wish, but even mention some wishes if pacers have kept you at bay for part of your life.  That will determine what device they choose and or what settings or both.

Brand is as mentioned above, some docs one brand.  My doc mixes it up, if one brand/model has an issue they dont have as many patients that need a replacement.  There is no better brand, all the major brands are good.

The brand has doctors/techs that work with your doc, think of it as a person with a briefcase handcuffed to their wrist hehe.  They show up with your pacer, spare stuff, leads, etc.  This is not their first rodeo, you are not an experiment, they know what to bring and what to prepare for.  The rep is there during the procedure.  My current doc gets my device a couple of weeks ahead of time and programs it herself.  

I have been at this for 33 years.  I have had medtronics, st jude, and boston scientific.  I have medtronic, guidant and boston scientific leads being used and a broken medtronic lead.

Because of how/when I started and when MRI tech came in, I have had a rule of never going into an MRI.  The tech has changed and my few year old current device is perhaps MRI safe with certain MRI machines that are new enough I assume.  But my old leads?  dont know, does this make me comfortable?  No.  I would rather just stay out of it.  I have no issues whatsoever of going through a metal detector or similar, it just upsets the security guard or TSA, so I tell them first and the wand me or whatever...

Your job is to have conversations with the doctor, not to research devices.  Prepare your house, if you have any heavy lifting you need to do in the near term do that before if you can, because for some number of weeks maybe months you may not wish to.  Plastic bags and tape so you can cover the thing and take a shower letting the steri strips stay on as long as possible before they fall off on their own, etc...

The docs job is devices and surgery and settings and interrogation, your job is communication and recovery.

Find a doc you trust, and then trust the doc you found.

Same Pacemaker suggested by my Doc

by Dbschroeder - 2020-11-05 10:53:30

VVG-

My doctors are prescribing a Bi-Ventricular Pacemaker, because of my Low EF of 20-25 and LBBB and Arthymia.

Scheduled for Dec 7.

58 yr old male, 6ft 3 217 lb.

Symptoms of occasional shortness of breath and light headedness when lifting weights.

I walk -jog 4-7 miles each day.

Let us know when your's is to be installed and how youre doing.

David