HIS Bundle leads with Boston Scientific pacemaner

Bundle of His

by AgentX86 - 2021-03-09 18:35:41

Medtronic leads can be used with Boston Scientific pacemakers but I doubt that anyone will do it out of the box. Mixing leads and cans makes the system unsuitable for MRIs. There probably isn't any reason behind this restriction but it hasn't been tested and it's not in anyone's interest to do the testing. The FDA, being a conservative lot, isn't likely to allow it and no one is going to risk their malpractice insurance.

It's news to me that Boston scientific can't do bundle of His pacing. There are articles about it but nothing that I can find says that their whole system can do it.

And His-bundle pacing isn't the only way to avoid LV-remodelling

by crustyg - 2021-03-09 19:18:49

The arguments for His-bundle pacing all revolve around trying to avoid LV-remodelling that can happen after long-term RV-apical pacing.  Pacing the bundle of His is the most physiological approach for those who need ventricular pacing, but there's a growing body of opinion that suggests that high-RV septal wall pacing may be nearly as good and easier to achieve.

Does your brother need ventricular pacing at all?  If he has SSS with a healthy AV-node then he shouldn't need vent-pacing.  I don't agree at all with the accepted interpretation of DANPACE, as a) many of the EP-docs who enrolled patients into the study put in two pacing wires anyway with no clinical indication at the time of implantation, and b) other studies suggest that apparent need for changes in DANPACE patients actually matched quite well the natural history of PM box replacement.

I think, in your brother's place, it's time for a full and frank conversation with EP-doc.  Choice of PM vendor shouldn't be wholly at the whim of EP-doc or any local deals that hospital(s) / providers have with Medtronic, or even - gasp - actual payments to EP-docs to choose Medtronic.  Get EP-doc to sign an affidavit that there are no inducements - financial or otherwise - in recommendation of Medtronic.  Will be a career killer at the malpractice hearings...

Options

by Terry - 2021-03-09 20:50:23

His bundle pacing is the only ventricular pacing method that produces a natural ventricular activation. The purpose is to avoid a dozen "deleterious effects" / remodeling. You no longer have to go to Mayo, for example, to avoid what your doctor calls "pacing induced cardiomyopathy' leading to heart failure in 1 of 7 patients after five years of pacing according to a recent study. See <His-Bundle Pacing Papers – His-Pacing.org (his-pacing.org)> for a sampling of scientific studies.

I would remain firm

by Gemita - 2021-03-10 05:27:48

Debra, you are doing an excellent job helping your brother and your posts really couldn't be clearer.  He is very lucky to have you take on this very technical task.  I would recommend you try the following.

I would go back to your EP and tell him firmly but respectfully that you do not want a Medtronic pacemaker and that you believe a Boston Scientific is the pacemaker of choice for your brother's particular lifestyle (share what you have learnt).  Be absolutely firm on this, as firm as your EP is on giving you a Medtronic!  Ask him politely if he is unable to help you, could he perhaps kindly refer your brother to a colleague of his who would be willing to implant a Boston Scientific instead?  The worst that can happen is that you will need to find another EP/cardiologist in a different location who will take on the task.  I see no other way, other than settling for a pacemaker that you do not want?

Tell your EP that you understand (apart from HIS bundle placement) that there are other good positions where a right ventricle pacemaker lead can be placed (mention the upper right ventricle septal wall area as mentioned in crustyg's post) and that you believe a Boston Scientific pacemaker could be used in this situation.  My right ventricle lead has been placed in my right ventricle septal area and I am doing very well with this set up.  I also have Sick Sinus syndrome (tachy/brady) and Flutter too.   (I have a Medtronic pacemaker but I am not a cyclist Debra and from what I have read on your previous link, you have done your homework well and come to a good decision with the Boston Scientific).

Regarding HIS bundle pacing placement, this can be difficult to successfully achieve because of the smaller area to find an optimum position for a good capture signal compared to right ventricle pacing placement.  This may increase technical difficulties of HIS bundle implantation, leading to a longer implant procedure, increased potential risks, even in very experienced hands. 

The other problem is that HIS bundle capture (compared to right ventricle capture) generally requires higher pacemaker energy.  This would lead to rapid battery depletion requiring more frequent battery changes and device change Debra is not without some risk, particularly infection risk.

HIS bundle placement is still in its infancy and we have much to learn about this natural means of pacing and whether any disadvantages will be outweighed by its benefits.  Only time and more clinical trials can answer this question.

You might care to discuss all these aspects with your EP so at least he knows that you have done some homework.  I hope your present EP is able to help you implant a Boston Scientific but if not I would look elsewhere

Acute hemodynamics

by Terry - 2021-03-10 12:51:41

DONNA49, I neglected to suggest that you ask any doctor whether natural, physiological ventricular contractions, produced only by the His / Purkinje system, isn't especially important for athletic activity, requiring efficient heart pumping function.

Blessings, Terry

Why does he need a PM?

by PacedNRunning - 2021-03-14 04:32:30

I ask because if he is not going to be pacing in the ventricles, he won't need HIS bundle pacing. If he is a cyclist he will want the Boston Scientific pacemaker. Better battery life than Medtronic and better customer service.  I went for a second opinion and that doctor wanted to take out my Boston and place it with a medtronic! No thank you!!  They can do the HIS bundle with a Boston Scientific but he may not be able to get MRI's if needed.  too bad Boston doesn't make a HIS bundle lead yet.  :(. Find a doctor that will listen. He should receive the Pm that works for him not the other way around.