Medtronic vs Other Brands

I'm wondering if anyone has had a Medtronic PM changed to another brand and if you're happy with the decision if you did.

I have a Medtronic Azure dual chamber and paced nearly 100% both Atrial and ventricular. I'm not happy with the rate response for many reasons. I want a PM with a rate response that is more physiological. 

I'm active and also find that during any normal work activities where my rate response should kick in, it doesn't. I've had it adjusted several times by the device clinic at the EP office, but they don't know how to fine-tune it any more than it is. I'm in the process of looking for a new EP with a better PM clinic to see if anything else can be done.

I'm getting ready to have my PM pocket revised soon and want to make a decision, in advance, if I want a different brand of PM so I can have both done at the same time. My current EP is sold on Medtronic, so it may also need to be with a new EP. 

I appreciate any info you're willing to share on this. :)

 

8 Comments

Biotronik

by Daedalus - 2024-11-17 21:48:02

Check out Biotronik's CLS mode.  


https://www.biotronik.com/en-us/products/crm/cls

Daedaus

by Amara - 2024-11-18 02:44:28

Thank you! That sounds like it will work well for me since I have sinus node dysfunction. 

Rate response

by piglet22 - 2024-11-18 06:55:37

Both my devices have been Medtronic in DDDR mode. The current one is an Ensura.

Cycling, mainly, was well catered for.

Recently, I've had more exercise fatigue and when the EP technician phoned in October, I mentioned it and he said "what you need is a more aggressive rate response".

It sounds as though even this older Medtronic device has scope for adjustments. As you say, it depends who you get as to what you get.

I would think that most manufacturers are up to speed on what installers and end users need. However, I doubt that all installers can be fully aware of all the settings and in particular, how they interact.

Biotronik - Boston Scientific - Microport

by Heike - 2024-11-18 07:06:37

My first was a single-chamber from Medtronic (Adapta). My second a dual-chamber from Biotronik (Eluna) with a CLS sensor. My last two are from Boston Scientific (Accolade and now Proponent). Biotronic works with a unique CLS sensor. Boston Scientific works with a combination of two sensors: accelerometer and minute ventilation sensor.

Both systems can be fine-tuned and both have their own advantages.

There is one more system with a combination of the two sensors: Microport (formerly Sorin if I'm correctly informed). According to the technicians from Microport, these sensors work physiologically better than Boston Scientific but the adjustment options are very limited and therefore fine-tuning is not really possible with them.

There are a couple of keen road-cyclist contributors who have moved to BostonSci

by crustyg - 2024-11-18 10:56:47

IIRC, at least two contributors have moved from Medtronic to BostonSci specifically for the Minute Ventilation rate response support for road cycling.

There's a lot of FUD (==Fear Uncertainty Doubt) about BostonSci's MV, and like all FUD it's wrong. For patients with SSS+CI who need decent RR during exercises that don't provide a lot of upper body movement, MV is very good, but it does need to be tuned for you by someone who knows the impact of each variable, and how much to adjust at a time.

I have found MV feed into RR ok for lane swimming (not great but better than nothing), and excellent for road cycling, in a peloton, solo up mountains, but it took a while to overcome the peloton effect.  Blended RR from accelerometer + MV worked well for me when I was still running.  Accolade only has a single accelerometer, which responds to forward/backward movement (perfect for stairs, running, some forms of dancing), but it is very adjustable.

RR is still well behind the natural, physiological sensors, but the tech is improving all the time. 

Piglet22

by Amara - 2024-11-18 23:40:17

Thanks Piglet22. You make a good point. 

Heike

by Amara - 2024-11-19 00:42:50

Thank you for the info. You've had many PMs.

I'm very interested in your experience since we have some similarity in our underlying conditions. I've also had IST and a conduction system problem within a year of the procedure for IST. I didn't have my SN ablated though. I had a SN sparing procedure, a hybrid ablation, mostly epicardial. I was at high risk for SM damage so I knew going into the procedure that I may need a PM. My SN failed, but there are some signs it's recovering. It will likely never function normally. 

Which PM did you like the best?

crustyg

by Amara - 2024-11-19 02:22:10

That's very helpful, thank you.

Your knowledge and info will help with my decision. I believe the MV would help me. I tried snorkeling recently, something I really enjoyed in the past. I couldn't do it because I found it very challenging to swim. I felt completely air starved. 

I've been reluctant to get back on my bike because of my current RR. I've been walking and doing other exercise instead. I'd love to start kayaking again, but not sure how the RR will act. I did with my single chamber PM without a problem but haven't tried since I got the new dual chamber. 

I found an EP about an hour away that I scheduled a consult with. He looks very experienced and trained. I asked around and hear good things about him. He implants all the PMs discussed here. It looks like he has a more advanced device team than I've been seeing. They do all their own monitoring and all RN device techs. The other clinics I've been to have a big company in another state doing the monitoring and they send a report to the clinic device tech if there's a problem or it's requested. They claim you can come in the same day if you have a device concern. Fingers crossed….. hopefully a good fit 😊

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