Replacement pacemaker choice

Excellent news

by Gemita - 2022-05-27 16:00:24

Selwyn, so glad you have got a date for your device change. 

Thank you for your good advice.  I think the truth is that I didn’t know about these things at the start of my pacemaker journey.  I remember just feeling relieved to be getting some help.  Didn’t really understand about dual lead pacing and the different types of devices, manufacturer and so on.  It was all pretty overwhelming to begin with and it is only through sites like this that I am slowly learning.

I believe my hospital in London mainly supports Medtronic, but I will certainly ask about other manufacturers when my device is changed (or well before).  In the meantime, you can test dance the Boston Scientific for me and get any bugs fixed before I step out onto the ballroom floor when my time comes round.

I hope the Boston Scientific provides you with a good device to suit your many activities Selwyn.  Good luck for the 10th June.

Persuasive Skills Needed

by IAN MC - 2022-05-28 06:28:45

While Gemita is cavorting around the dance floor  , I too am having a replacement PM fitted...some time in the next 6 weeks. 

I continue to have problems persuading my NHS cardiologist to fix a Boston box to my Medtronic leads though. He is concerned that "there is no published evidence "  on the safety of doing so.

C'est la vie

Ian 

PM change

by Selwyn - 2022-05-28 13:34:09

Ian,

It took all of 24 hours to get an answer on lead compatibility as I go from a St Jude Medtronic to a Boston Scientific. At the end of the day a wire connection has to be made. I can't think why this needs published evidence any more than wiring a domestic electric plug with wire needs writing about.  I see, looking at previous posts, you discussed this problem in 2018 on the Club site.  Your consultant was unwilling to swop and change.

It appears that there  is an  industry standard for the diameter of pacemaker leads.Since the late 1980s and early 1990s, the unified industry standards IS-1 and DF-1 ensure interchangeability of generators and leads from different manufacturers, thus allowing the device system to be tailored to the individual patient's needs.

( Ref:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404557/).

The DF-4 standard was formalized in 2010 as a four-pole inline connector system and was endorsed by the Association for the Advancement of Medical Instrumentation in August 2011. The standard allows interchangeability from all manufactures and ensures compatibility with future implanted devices. 

( ref.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032777/)

Personally, I would print this off and then have a further discussion with your consultant!

Also see,
Introduction of new industry standards for cardiac implantable electronic devices: balancing benefits and unexpected risks.
Sticherling C, Burri H.
Europace. 2012 Aug;14(8):1081-6. doi: 10.1093/europace/eus034. Epub 2012 Mar 1.
PMID: 22389420 

ANSI/AAMI/ISO 27186:2010 - Active Implantable Medical Devices - Four-pole Connector System for Implantable Cardiac Rhythm Management Devices - Dimensional and Test Requirements [Internet] Association for the Advancement of Medical Instrumentation (AAMI); 2013. Available from: http://www.aami.org/publications/AAMINews/Feb2013/New_Approach_to_Standards_Development.html. [Google Scholar]

 Best of luck,

Selwyn 

Choices in Features ?

by Marybird - 2022-05-28 13:45:51

Just wondering if the NHS allows you some choice in the brand or model of the pacemaker you receive, might those choices extend to features like, perhaps, wireless-enabled generators and monitors for remote monitoring? If your condition warrants this feature, that is.

Thanks Seĺwyn.....Will do !

by IAN MC - 2022-05-28 13:53:18

As you know,being a medic yourself, your colleagues exhibit the whole range of risk-aversion  ..even though negligible risk may be present. 

Fortunately  ,with advancing years and reduced sports activity the superior Rate Response offered by Boston Scientific is becoming less relevant...but I will try one more time!

Thanks 

Ian

Choices in the future

by AgentX86 - 2022-05-28 14:18:49

I think all cuurently available pacemakers are Bluetooth(LE) compatible. Data formats and the infrastructure between the PM and the mothership is very unlikely to be the same. The  programming hardware is certainly not standardized. There is likely to be a lot of IP in there.

Consequences of choice

by atiras - 2022-05-28 16:23:06

My experience was that device choice within a manufacturer range was driven both by clinical need and lifestyle factors (if you were informed enough or had time to do the research in advance, and persuasive enough to articulate your needs) but manufacture choice was down to an NHS trust and there could be complications if you moved between trusts. 

Bristol gave me a medtronic single lead pm with medtronic lead after pace and ablate. 

Swindon were happy to take that on and manage it. 

Birmingham put in a Boston scientific ICD with bells and whistles but left the monitoring to Swindon plus a bs lead as the medtronic one wouldn't support an ICD. 

Swindon had no experience, no remote nitor and no money in the budget to provide a remote monitor. 

It was an ongoing discussion between the two trusts as to whose responsibility the remote monitor was, not resolved by the time the ICD was removed. 17 days ago. 

So i would be wary of pushing for something outside your trusts comfort zone even if you could get it. 

Marybird

by Gemita - 2022-05-29 05:19:02

Hi Mary, We were not given a choice of pacemaker model or manufacturer under the NHS at the time of our pacemaker implants (both in 2018).  Perhaps it is different today, especially for those of us who are able to express a preference, based on our lifestyle and condition.  

At the time of our implants, we were only told about the likely benefits and risks of having a pacemaker.  I don’t even recall being told much about the longevity of battery and leads until I asked.  ?Perhaps they thought our pacemakers would see us out?

I think it largely depends what the hospital has in stock and which manufacturer the hospital supports.  To my knowledge both our large London teaching hospitals we attend mainly use Medtronic, unless patients successfully request otherwise.  

We both have sinus node disease and AF and had evidence of syncope/collapse before implant.  I received a dual chamber pacemaker and was given a home monitor at the start of my care. My husband was given a single lead pacemaker and was not offered home monitoring.  I have never really understood why my husband didn’t qualify for two leads or a monitor at the time, although he was initially treated in our local hospital as an emergency case, so may be that made a difference.

I believe patients who attend a main, large teaching hospital as opposed to a smaller local hospital will have more opportunity of getting the device of their choice, but another question for my team when I see them in early July.  I have already established that my husband’s hospital only supports home monitoring for ICD patients.

Thank you, Selwyn

by LondonAndy - 2022-05-29 07:41:35

I have read articles about lead compatibility before, and was surprised this could be an issue since, as you say, it is simply an electrical connection. So thank you for your research into the standardisation, enabling choice.

My Medtronic is approaching its end of life, and I am expecting a replacement within the next six months or so at Barts. Good to know there are options, and judging by the fact they always have to swap over the testing machine to a Medtronic they clearly support devices from multiple manufacturers.

Choice of model

by TonyD - 2022-05-29 12:04:51

I had no idea about PMs and certainly nor that there was a choice. Had mine fitted in Norwich and was given a Vitronic with dual chamber leads.  What difference would another brand have made I wonder? 

Making Our Own Pacemaker Choices

by Marybird - 2022-05-29 13:34:12

Tony, I would think most of us pacemaker recipients are in the same situation as you ( and Gemita and her husband, from what she is saying) in knowing very little about pacemakers, let alone brand and features among the choices out there. When my EP informed me it was time to put one in, he told me nothing of the details, and it was the scheduler at the front desk who informed me it would be a St. Jude dual chamber. I do recall at my first visit with the EP when we discussed pacemakers he mentioned that one of the big advantages of a pacemaker ( though not the reason for implanting one) is that "he could track my tachycardias", so there is a hint he was looking for wireless remote monitoring and alert features. I knew of the St. Jude brand ( I had had a neighbor who had one) but I had assumed I would get a Medtronic as everyone else I knew with a pacemaker ( including my sister and daughter), had Medtronics. But I've been happy with my pacemaker and the settings have worked well for me, so the only request at this point I would make at a generator replacement ( hopefully a number of years down the road) would be to put in an updated version of the same make and model and leave the same settings as they are now. That's barring any changes in my cardiac health status, in which case I'd have to leave any new settings up to the doc.

I could see someone with an active athletic type lifestyle wanting a pacemaker with the most enhanced, most sensitive rate response feature available, and requesting a Boston Scientific model that would provide that feature enabling them to live their active lifestyle to the highest extent possible. And I can see having to be pretty emphatic about wanting to maintain my active lifestyle to the maximum, as well as the frustration that may well occur when the EP and crew are reluctant to see anything but a long in the tooth retiree (pensioner?) whose exercise consists of channel surfing on the couch, not the vibrant, healthy active senior making those requests for a pacemaker that will keep up with his exercise demands. 

I'm not so sure ( though that may be my own ignorance), that other than that, there are all that many differences in the various brands or even models of pacemakers that would require "fitting" one model/brand over another to best suit an individual and take care of his/her pacing needs. They seemed to like the monitoring/alert function on my St. Jude Assurity pacemaker (,as the docs say, they saved me from a stroke when they caught the afib in those alerts) but I'm pretty sure the same functions are available on the Medtronic, Boston Scientific and other models. So at this point, I'd leave the choices up to the implanting doc, who knows my health needs and a whole lot more about pacemaker features and settings than I do. 

I'd also think about the issues that Atiras mentioned with who's in charge of what and round robin processes with the NHS when a patient requests a brand or type of pacemaker not normally handled by the hospital which provides his/her care. I don't how easy it is to adjust the process to accomodate the patients' requests ( it'd take an act of G-d to plow through the needed referrals here in the States) but I can't think that the delays and round robin processes would make for the best patient care. 

From what you're saying ( Atiras and Gemita), it's most likely not as easy a process as one might envision. I hope you'll be able to get some good answers to your questions and good information during your upcoming visits in July, Gemita. And that includes information about remote monitoring policies and why/why not specific individuals are apparently deemed not eligible when according to their diagnoses they should be! 

That’s great.

by PacedNRunning - 2022-05-30 15:04:29

That's great information! I have a Boston Scientific' and my EP chose this one knowing I exercise heavily. I don't use the MV sensor at this time but it's there if I ever need it. It's a great feature.