Kevin 2.0

Just had my first replacement Medtronic ICD installed today and everything went very smoothly. The original and been put in up in NYC at Lenox Hill hospital in April of '07, and since we are now living in Myrtle Beach the replacement was done at the new heart center at the Grand Strand medical center. I was very impressed with my new EP and his lab team and the hospital staff as a whole. Showed up a 6 AM this morning and was out of there by a little after noon. Need to take it easy for about a week and then I can hit the links again as they didn't have to mess with the leads at all. The Doc told me the new improved ICD should last about 7 years this time even with my constant pacing. He also said Medtronics modified the device's algorithm to make the fidelis leads I have much less likely to malfunction and cause unnecessary shocks. Much more pleasant overall experience than I had imagined.

8 Comments

pacing?

by sernarama - 2012-09-06 05:09:29

So do you have a combination pacemaker/ icd? I am not really sure exactly what my condition is, but I have a Medtronic pacer / icd. I can't imagine leads malfunctioning and causing unnecessary shocks. Good luck with the new device.

Projection

by PacerRep - 2012-09-06 06:09:29

Just remember that everything is a projection, companies are touting the longevity of their devices "I have 8 years", "we can do 8.5" etc. But its all a projection, there are many factors that are different for each person that effect this, it is just a ballpark.

Do not write off the Fidelis problem, the algorithm does not help at all if you get fracture in the wire, its going to shock you many times. If you are not on a home monitoring unit, I highly suggest you speak with your doctor to obtain one, that way they can monitor the lead on a daily basis. Trust me, when and if that Fidelis lead decides to give out, getting 30 shocks in 1 hour is bad news for anybody.

Just my 2 cents.

Sernarama

by PacerRep - 2012-09-06 07:09:41

Just so you know...Nobody makes an ICD without a pacemaker built in. you can have a pacemaker without the Defibrillator, but not the otherway around. Even if you don't need pacing, if you have an ICD you have a pacemaker as well. The reason is that after defibrillating a leathal arrythmia, sometimes the heart needs the pacemaker to kickstart it, so after a shock devices are programed to immediately start pacing to get the blood moving just in case your heart is trying to take a nap.

Clarifications, etc.

by kmcgrath - 2012-09-06 08:09:49

I have those fidelis leads that had been recalled and the EP doc said they most likely will have to be replaced at some point. I do have the bedside monitoring device that transmits my ICD/pacemaker's status regularly via the phone line at least every three months or sooner as scheduled. The device will also generate an audible alarm if that feature is enabled. It sounds like a French ambulance alarm but, at least in my case, you have to be in a quiet place to hear it. (also someone being awake helps too. lol)

PacerRep

by mike thurston - 2012-09-07 06:09:41

So I had my pm/icd replaced in Jan. First one lasted 4 and 1/2 years. I am seeing my EP next week. I called awhile back and talk to the nurse about the darn thing not being sensitive to exercise. When I bike, walk etc. it pretty much goes to 95bpm. (my settigs are 80bpm-140bpm) It reacts better with aerobics where I move around a bit. Basically I have resorted to tapping on it as I know from monitoring it that it will increase with the tapping. Anyway that's not a very efficient technique. Is this most likely a rate response issue ? Also I am totally dependent with no underlaying escape rhythmn. About a 1/3rd of my heart is dead from an M.I and I am in permanent A-Fib (no longer feel it). I got the ICD part because at that moment my EF was 15%. The EF is now around 50%. Never been shocked, have the Fidelis lead, never had Vtach that I know of. How much would you recommend keeping a magnet around in case the lead malfunctions ? Will an ordinary refridgerator magnet work (I think it will) I discuss not getting the ICD this time with my EP and I could tell he was on the fence about it. Anyway I feel like a 30 shock storm could do more damage and it seems unlikely that I will have vtach as I have pushed to utter exhaustion (mountain Biking etc) and just stop and rest with no issues. Would feel much better if I knew I had a magnet to turn the ICD off. Seems like a logical idea to me. I am not gonna live forever and the mental damage as well as the possible damage to my heart from a shock storm stress me way more than the thought of dying from a heart attack. Just curious what you think. Don't worry, not trying to circumvent my EP, he is great and I trust him. Problem is they are all so busy that it is hard to get lots of this on the table except about once a year.
thanks
Mike

Ok good to know

by PacerRep - 2012-09-07 12:09:18

Also with those home monitoring units, even though you do you regularly scheduled 3 month transmission, there are certain parameters that are programmable within your device that will "trigger" the unit to send an alert to the monitoring station. For instance, the big problem with the Fidelis is that over time the conductors within the insulation of the lead tend to break. Its basically the cyclic loading and deloading it takes from every single heart beat (think about a paper clip, when you keep bending it back and forth it eventually breaks right?). When the break...or better known as Fracture...occurs, electricity kinda gets stuck around the break and sorta keeps shooting back and forth, the device interprets this as a heart beat.....a very very fast heart beat and it delivers therapy as it is programmed to do.....When the fracture occurs a measurement known as Impedance goes through the roof, we can program the home monitoring unit to send an alert when the upper limits of the impedance measurements are exceeded. It's just a good safety net to have. I personally feel that all fidelis leads should be monitored remotely, but hey what do I know? Also, I wouldn't say that the fidelis will "most likely" need to be replaced, i think the failure rate is just under 15% so the odds are in your favor. But the flip side of the coin is that nobody knows how this lead will behave after 10years...12years...15years??

That last post

by PacerRep - 2012-09-09 02:09:14

was for Mike Thurston

Good ideas

by PacerRep - 2012-09-09 02:09:31

Definitely need to make your Rate Response more aggressive. This is easy, just have your tech do it at your next check, they should know how.

So here's what I would be doing if I had a Fidelis.

1) Have a Home Monitoring unit
2) Get checked at a minimum every 3 months. Obtain a printout each time for my own records
3)On the Printout look at the "Testing" section. Look at the Ventricular (or V-lead) Impedance values. Write them down somewhere and track them yourself

What you are looking for is a rise in impedance. So lets say its 600Ohms in janurary, then in April its 700, then in September its 900. Its starting to fail. We allow a 20% fluctuation in the value based off of the impedance at implant. Ask your tech what it is.

So if at implant the impedance was 500. If its getting deep into the 600's i would start to watch it more closely. If its showing a constant trend of increase. I would keep that magnet in my front pocket at all times, also tell the E.P. to insert a new "pace sense" lead cap off that portion of the Fidelis. (if its trending tword higher impedance)

A defibrillator lead has 3 sections. the problem section is the pace sense portion. So they can just deactivate and cap off that portion of the lead and put a new one in...problem solved.

I don't believe a refridgerator magnet would be strong enough. Call your company and request one, they might say no but can help you in finding one. You could also ask your doctor he gets them for free.

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