Shopping for new PM

My medtronic kappa 400 just went into end of life mode and I'm shopping for a new PM. I have chronotropic insufficiency which means my heart can’t get above 100 bpm unaided. My kappa has accerometer and MV sensors. Using the accelerometer as primary sensor caused my heart to be overpaced which led to a (thankfully) temporary heart failure diagnosis . Most recently after an adjustment at the Mayo Clinic (Sports Cardiology) it was using MV as primary and was working OK. Medtronic no longer uses MV sensing so I’m looking at the Boston Scientific Igenio / Advantio PMs. Any experience / comments on these devices would be very welcome.

Cheers - Paul

7 Comments

rate response

by Tracey_E - 2013-06-06 01:06:44

If Inga (snitch) doesn't chime in, do a search of her old posts or send her a private message. She is extremely well versed in the various rate response features out there and has posted more than once.

It doesn't get any better than Mayo, what do they suggest?

New PM

by paul6000 - 2013-06-06 02:06:20

@TraceyE 'It doesn't get any better than Mayo, what do they suggest? '
I haven’t checked with Mayo yet I plan to visit with my local EP next week and then check back with Mayo if I’m not completely happy with his recommendations. You’re right about Mayo though. I like to run and my visit there was the first time anyone checked my PM while I was running on a treadmill.
Cheers - paul


MV sensor

by golden_snitch - 2013-06-06 04:06:09

Hi Paul!

I have a Sorin Reply DR with accelerometer plus minute ventilation. Great pacemaker with lots of fancy stuff, and it's the smallest dual-chamber device! Not sure about the Boston Scientific, only know that it has MV, too. Should do the same job. And especially in the US, Boston is much better known. I picked the Sorin because at that time I also had intermittent heart blocks, and the Sorin pacer came with a special and very efficient feature to reduce ventricular pacing; Boston didn't have that, only Medtronic does, but then Medtronic didn't have the MV sensor any longer. But if you don't need any ventricular pacing at all, so only have sinus bradycardia, the Boston Scientific might be just as good for you.

Best wishes
Inga

Vielen Dank Inga!

by paul6000 - 2013-06-07 04:06:05

Vielen Dank Inga! I’ll take a look at Sorin. I do have a right bundle branch block and have dual leads with V pacing. I emailed Medtronic to ask why they discontinued MV but no response yet.
Cheers - paul

Medtronic comment on MV

by paul6000 - 2013-06-07 05:06:20

I asked Medtronic why they discontinued the Minute Ventilation sensor. Here’s their response:

QUOTE Thank you for contacting Medtronic Patient Services. Medtronic chose not to continue with the minute ventilation sensor in future pacemakers. New diagnostics and algorhythms [sic] in our pacemakers found to be more of a benefit to patients. /QUOTE

So it looks like.
1. No definite negatives associated with MV
2. These guys can’t spell very well or maybe they’re appropriately fixated on rhythm 
paul

Medtronic

by golden_snitch - 2013-06-08 02:06:42

Hi Paul,

I asked some Medtronic guys, too, and they simply said that it turned out most patients don't really need the MV sensor, they do well with accelerometer only. I guess the group of patients who needs MV + accelerometer is probably too small, so that most manufacturers think it's wasted money to produce pacemaker for such a small group. I also asked whether Medtronic is planning to develop their rate response algoritms any further, but again, no they are not because people get along with what Medtronic offers at the moment.

Every EP I know has, however, told me that MV + accelerometer is the best rate response you can get, and that it really matters in active patients with sinus node issues.

If you do have some ventricular pacing, taking a look at the Sorin Reply DR is worth it. However, if you're paced 100% in the ventricles, then you don't need any special features to reduce ventricular pacing, and therefore the Boston Scientific pacemaker might be an option for you, too.

Inga

Pulled the trigger

by paul6000 - 2013-06-18 07:06:11

After a week of looking at options & specs I finally decided on a Boston Scientific Ingenio K173. It was installed yesterday and fortunately they were able to use my existing leads. The PM tech used my medtronic settings as the basis to set up the new PM.

I did some running this morning – just a few miles to check the new unit out. It felt great after a couple of weeks of being stuck at 65 bpm. The rate response seems to be very natural – far better than my old kappa 400 so I’m feeling good about my choice so far.

Cheers -paul

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