Pacemaker battery nearing the end of power.

Have time to explain?

by brady - 2023-03-22 00:40:41

Sorry, What does "device changed" mean? Change Leads and generator?

Device change

by AgentX86 - 2023-03-22 01:09:47

It seems that Medicare doesn't have any hard requirements for replacement.  I think you need to ask your cardiologist more questions.  I can understand if they want to wait until ERI.  Depending on the PM, this may not be so great because, depending on the pacemaker, switches to "magnet mode".  This mode sets the rate to a constant rate and to VVI mode.  If you're used to other modes, you're going to really feel this.

Anyway, here is an interesting Medicare pacemaker prices document.  The relevant part about replacement:

"Q1: Does a pacemaker have to be at end of life (ERI) for the changeout procedure to be covered by Medicare?"

A1: "There is no policy from Medicare on device changeout coverage. Instead, coverage will be based on documented medical necessity."

<https://www.medtronic.com/content/dam/medtronic-wide/public/united-states/customer-support-services/reimbursement/pacemaker-therapy-reimbursement-health-policy.pdf?bypassIM=true>

ERI or EOL?

by Rch - 2023-03-22 02:34:47

Hi, I notice you had the implant in 2017, and is it already now ERI for the generator? You would need to confirm that with your Provider. If you have a transmitter at home, you could check the battery status on the your phone-app. In any case, if it's ERI (ERT), you may only have 3-4 months of service left! If EOL you need one ASAP. Modern day pacemakers do switch into a safety mode to VVI upon approaching EOL, and start sensing and pacing the ventricle at a programmed rate. The only drawback of this mode is that you lose 1:1 AV synchrony and consequently might experience brief periods of dizziness like symptoms due to diminished stroke volume ( pacemaker syndrome). 

cushion

by Tracey_E - 2023-03-22 09:58:38

Know that it is not going to suddenly stop. There are built in safety measures at the end to protect us. It would be very rare for insurance to cover before it's elective replacement mode. Ask to clarify, but that would be my guess where you are about to be. When it's ERI, it's still fully functional for about 3 more months, so plenty of time to get it done. 

After that time, it goes to EOS/EOL, or end of service, which is when it cuts back and doesn't feel so good. It won't let our rate get below 60 so we are safe,but when we have av block, it won't get our rate any higher than that. Some insurance requires this but it sounds like Medicare is not one of them. This also lasts 3 months.

Ask them what your underlying rate is. They usually check mine before replacement by turning the pacer down enough that I'm beating on my own. I also have CCHB. My rate has been anywhere from 60 to 20. Just because we pace every beat doesn't mean our heart will stop if the pacer should stop. We will not flatline. 

I'm on my 5th and know that the end is stressful. I've never been EOS, it's always been replaced when it's still ERI. It will work out. If they told you a few weeks, that most likely means a few weeks to ERI which really means a few weeks + 6 months. 

Replacements are super easy. If your leads are good, they will simply test them and leave them alone. They should go in the same place so it's all scar tissue. Most of the restrictions the first time were the new leads so this time it's just the incision healing. If I get an early appointment, I'm home fixing my own lunch. Last time I came home, took a nap, then answered some work email. This is nothing like the first one. 

If you have any questions, please feel free to message me. Been around this block a coupla times ;o) 

My Daughter Did Reach EOL With Her Pacemaker

by Marybird - 2023-03-22 12:40:20

......which was implanted in 2012. She knew it was getting close but didn't keep up with her transmissions to the clinic while it was in the ERI mode, apparently. She woke up one morning and realized something was different, with her pacemaker pacing at a steady 65, regardless of what she did. She knew this was EOL with the pacemaker.

She's pacemaker dependent too, but this one in EOL kept her going for a week until she got the generator replaced in the summer of 2020. She felt a serious lack of energy, and just overall not great, but nothing life threatening. She has a job where she's required to be very active, and she took a week off work and just rested till she got her new pacemaker.

Agee with others

by PacedNRunning - 2023-03-22 14:09:38

They are just looking for the notifications to replace. You still have plenty of time to get it replaced once the notification starts. They won't let it get to Eol. EOL and ERI are 2 different modes. EOL would be a stat change if you are dependent. ERI they have 3 mos before it goes to EOL. If you have Boston the mode doesn't change at ERI. It will still function at 100%. Medtronic and others dial down at ERI. I don't think it's an insurance issue as pointed out above. It's waiting to get closer to ERI mode 

I'm due soon and was told they would change it in ample time before ERI. I also am 100% dependent with complete HB 

ERI and EOL

by Marybird - 2023-03-22 17:40:01

It's my understanding ( from what I have read on the topic) that any pacemaker in ERI will function normally. It's when the pacemaker gets to EOL that the pacemaker will be limited to constant pacing at 60-65 BPM, with its other functions disabled. The pacemaker will continue in EOL for a total of three months from the start of this mode, so it's not a drop everything, risk life and limb to get to the hospital and get the new pacemaker right now type situation.  It's more like an ASAP type situation, as many people don't feel well with their pacemakers in EOL, and also letting it go and losing track of the time left in EOL would be akin to running your car with the gas gage on empty, you know there is some gas left, but you don't know how much or when it will run out.

My daughter had her pacemaker generator replaced after her old pacemaker had been in EOL for a week. 

Not correct. For EOL

by PacedNRunning - 2023-03-23 04:59:32

If you are dependent and hit EOL. It's get to the hospital! Pacing may not be reliable. ERI you are ok for 3 mos. Or should be.  Anytime you HIT EOL it needs to be replaced ASAP for anyone highly reliant on the device. They should send you straight to the hospital for replacement. Different brands slow down differently. Medtronic will pace at 65 bpm only in the ventricle at ERI. Boston will continue 100% until EOL. Once EOL Boston will dial down to 50bpm. Abbott and Biotronik are the same as Medtronic. This is when I'm thankful for Boston. Once I hit ERI, nothing changes for me. Then I have 3 mos to get scheduled but I'll have mine replaced before ERI according to my EP. It's not safe to ever go to EOL if it can be avoided. 

EOL

by Marybird - 2023-03-23 09:49:49

As I mentioned before, at EOL- which admittedly is a place no one with a pacemaker wants to be, the pacemaker will pace at a steady 60 to 65 beats per minute, with other functions suspended to preserve the remaining battery power. At the outset of EOL, the pacemaker will continue its basic pacing function for 90 days. Since many pacemaker recipients feel unwell, to the point of being unable to carry out their normal activities, when they have reached EOL, and there is a limited time before the pacemaker stops working, the pacemaker must be replaced as soon as possible, particularly in a pacemaker dependent patient. But even a pacemaker dependent patient can be sustained for some time in EOL, there is no need to drop everything, rush to the hospital immediately for an emergency pacemaker replacement at the onset of EOL. The replacement could be scheduled within a day or two, as surgeons and cath labs/ERs are available. As I mentioned, my daughter's pacemaker ( Medtronic) was replaced one week after the onset of EOL. Her underlying rhythm is AV junctional with a HR of 35-40, which starts up with a delay of about 30 seconds after her pacemaker is turned off. For that 30 seconds, she has no heartbeat. 

Again EOL is not safe if you are dependent

by PacedNRunning - 2023-03-24 04:22:02

She has an underlying beat so technically she is not dependent even though she paces 100%. Various definitions on this. But in my eyes of the many definitions, she and I both qualify for dependenr. EOL is not safe! She must have been in ERI. EOL For a week is unacceptable when 100% paced. Medtronic dials down to 65bpm at ERI. At EOL it's the same for them. Others dial back at EOL

I think you may have misspoke. The Device will not allow 30 seconds of no heart beat. She would pass out. It will back up pace at 30 bpm until they can  determine if she has an escape. But no device will allow someone to flatline for 30 seconds. It's a device safety net 

She Was Definitely in EOL for A Week

by Marybird - 2023-03-24 10:21:35

We were there, her EOL was documented by the pacemaker clinic. They were still able to retrieve her pacemaker records from an in clinic interrogation, grateful that the voltage had not yet declined to where the pacemaker was unable to respond to an interrogation. From this information they were able to determine the exact date and time her pacemaker went into EOL. EOL, NOT ERI. It can be rough for a patient in EOL, and the patient's providers would not deliberately let a patient get there, will schedule a pacemaker replacement as soon as possible, but the patient CAN be maintained, albeit at a reduced level of activity on an EOL mode until the pacemaker is replaced. This is not a situation my daughter or her family would have chosen, for sure, but this was in June 2020 when covid restrictions were causing all sorts of cancellations and delays. 

A pacemaker will "allow" a 30 second delay when it's turned off during an in office interrogation, and they always had my daughter lying down on an exam table when they did it, so if she passed out, she didn't go anywhere. 

You're free to believe your version of "everything you always wanted to know about pacemakers but were afraid to ask", of course, but I really do not appreciate your repetitively casting aspersions on our personal ( and validated) experiences with my daughter's pacemaker at EOL. I'd hope that with a little more research on your part, you'd reach  a little more understanding about how these devices actually work, in particular their safety features when they reach EOL, but I'm done here. That's all. 

30 seconds without pacing. Not possible

by PacedNRunning - 2023-03-25 00:02:17

The programmer will never allow the HR to fall below 30bpm. Maybe you mean 30 bpm not 30 seconds. It would put a patient at high risk of cardiac arrest if they allowed their heart flatlined for 30 seconds. They will look for up to 30 seconds for an underlying rhythm all while providing back up pacing at 30 bpm. You have to allow the heart to wake up with abrupt stopping of pacing. 
 

EOL will still pace it's just NOT reliable they must have felt she was safe to wait but if it's as you describe flatlined for 30 seconds that would more of a reason to replace ASAP. 

A lot of people confuse ERI and EOL. Something doesn't seem right if she was at EOL, dependent and could wait.