Replacement of pacemaker

I had a dual chamber pacemaker implanted 10 years ago. This was due to A/V block and sick sinus syndrome. I have had no problems with it, I am physically active. I am 66 years old.
During the last check-up they told me that I had a minimum of 4 months of battery life left. This is in addition to the 3 months of “reserve mode” that kicks in when the main battery is too low.
I am quite dependent on the pacemaker. When I first had it implanted my natural heart rate was in the 40’s. Now it is below 30’s, but it is not clear how much lower. At the clinic they didn’t want to test to find out.
The hospital folks told me that there are two ways to handle this:
1) Aggressive: wait until the last moment before replacing. The rationale being that I may still have 1 to 2 years left of battery life, and I shouldn’t have surgery sooner than necessary
2) Conservative: replace the PM now; don’t wait until it becomes an emergency.
Has anybody had to deal with this situation? Any suggestions?

Thanks!!

5 Comments

I'd much rather

by Theknotguy - 2014-10-24 09:10:49

Past painful experience dealing with crisis situations has taught me it's always best to work in a non-crisis situation.

While I don't have to have my PM replaced for about 10 years, I'd still want to go the conservative route.

I'd want everyone to be unhurried and thinking through each step. They're less likely to make mistakes that way.

I did ask the nursing people how they switch out a PM when you are 100% pacing. They said the most important thing is to keep the heart beating - which they do. So you don't have to worry that you'd be on the table without your heart beating while the doctor fusses around trying to get the new PM working.

Hope things go smoothly for you.

replacement

by Tracey_E - 2014-10-25 10:10:25

Do it before you go into EOL. There's no rush to do it this week but doing it early means you can schedule it at your convenience and you won't get to the point where you feel bad. You have a good window, lots of time to decide when. I'm on #4 and have done it this way each time. They told me when I had a 3 month window, I chose when to do it within that time frame.

I don't know why they'd call it aggressive and conservative! That's overdramatizing, imo. I needs to be done, it's just a matter of when. Common sense says don't knowingly choose to wait until you feel bad. That's not being aggressive, that's using your head.

That said, some insurance won't cover it until you are EOL.

Replacement

by Many Blessings - 2014-10-25 10:10:58

Hi,

I am 100% dependent/paced too, so I was really concerned after reading others posts on how crappy they felt when it was time to get theirs replaced.

I haven't had mine replaced yet, but we have discussed it at my cardio doc visits in the past. I have been assured that due to the fact that I am 100% dependent/paced, a base/escape rate below 20, numerous other cardiac issues, and the type of CRT-P I have (St. Jude) that they will not let me get to the point where I will feel it like others have mentioned.

That being said, I was told it also depends on your unique situation, what brand of PM you have, what insurance you have, as well as what the cardio/EP docs advise.

My best advice is to ask your EP/Cardio docs and PM tech, they will be able to answer you the best, because they know your medical history, your situation, your insurance, etc. You can also call your PM manufacturer company to see what they say.

Replacement of pacemaker

by Enrique - 2014-10-26 11:10:46


-The technnologists in the PM clinic say that, although I still have a minimum of 4 months left in the batteries, it is possible that they may last for another year. They say that forecasting battery life is not accurate. They think that I can wait.
-But my doctor doesn't want to take risks, given that my natural rate is below 30 bpm
-I agree with my doctor. We are requesting replacement of the PM before the 4 months are up.
-I have a Medtronic dual chamber PM.
-I don't expect that insurance will be an issue. I live in Canada and the Canadian health system will cover it if the doctor requests the change now.

Thank you for your comments!

at the end

by Tracey_E - 2014-10-27 08:10:35

At the end of the life of a pm, there are two modes. ERI is elective replacement which lasts about 3 months. During this time, it is fully functional and you won't notice a difference. It's like the gas light in the car, a heads up but the car runs normally.

EOL is the next phase, end of life. At this point, it cuts off extra features and begins to pace at a steady rate, usually 60. For those of us who pace all the time, we will feel this instantly. It doesn't feel good, but it's not dangerous either. The pm is keeping us safe at this stage, that's it. My point is, your rate will never drop to 30, even if you wait a few months. There is a cushion built in so until you hit that point where you switch to ERI, you have at least 3 months. It sounds to me like the techs want to wait until this stage (which imo makes sense), but your dr wants to do it now.

They are correct, the number is an estimated range. Mine has said 12-18 months for the last year, hasn't changed my last 4 checks. I usually wait until it goes to ERI then choose a date. I have never gone EOL, I've always had plenty of time once it goes to ERI. My underlying rate is 20 to 50, depending on the day.

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