The countdown has started

God bless!

by Lavender - 2024-07-12 11:24:20

We are on a similar path. I had a check in July and next will be in October. My device is almost 3 and a half. I have a Bluetooth so I betcha you get one! 
 

I too wonder if I will be externally paced with my eventual pacemaker/lead revision. Still awaiting the battery wear down. You're ahead of me on that. 
 

In any case-what choice is there-? On we go!

We will be with you every step of the way

by Gemita - 2024-07-12 14:34:43

Hello Piglet, I think it will be for you to alert your team of any new symptoms you experience which could indicate a sudden decline in battery function and you will probably know well before they contact you about the need for replacement.

In the meantime, I would spend the next few months asking about the pacemaker manufacturer and model you are likely to get.  Hopefully it will be the right pacemaker to suit your needs this time, if such a pacemaker exists?  You will no doubt get a bluetooth device but I would find out what pacemakers are available in your hospital, if you have a choice of manufacturer, and what new algorithms have been developed since your last model to help with some of your symptoms.   Now is the time to ask questions Piglet, and not to wait until a battery change becomes a medical emergency.   Who knows there may be a clever new PVC algorithm waiting to be tested.  I live in hope for both of us.

Thanks both

by piglet22 - 2024-07-13 08:02:53

It's good to know that people care.

Lavender

You do have some time to go yet. What makes me apprehensive and I'd be lying if I said I wasn't, is that I have one fully preventable botched replacement behind me.

Despite the 3-monthly checks saying otherwise and it really was time to change the device, they decided to see if it would stretch to 11-years. It didn't, and I don't want to go through that again. Mode change from bipolar to unipolar. Spoils your day.

I’m hoping that getting a Bluetooth enabled device will give me a bit more security if something went wrong.

Right now, if I needed to transmit data, I would physically need to get to the monitor to get the reader onto my chest.

Gemita

I think we're in tune on many of the problems of ectopics etc. I'm not sure if mine have simply gone away or are being supressed by the Bisoprolol. The EP tech did say there was no recorded evidence.

It will be interesting when the time gets a bit closer, to see exactly how they process me. I have to say I'm not confident. As for choice, they should have plenty of evidence from my history and I wonder how much influence the procurement people have in this. I've no doubt there are some pretty tight deals done in the NHS. It might be different in the private sector, though you might reasonably expect the clinical advice to be the same.

Just out of interest, I looked at the costs of pacemakers. Of course it varies widely with surgical costs etc., but it does seem to be more expensive in USA than Europe.

On a cost of device per installed day, it works out at £1.77 per day. Here's a link where that came from.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577564/

Obviously that depends on how long you have it, but it's probably less than the pills I have every day. The actual hardware once at production stage is relatively cheap, and as far as complexity goes, probably on a par with a mobile phone, maybe less. The surgical costs are probably much the same for whatever the generator is, so there’s no argument for going for the cheapest option.

The tech was slightly taken aback when I described the falloff of exercise tolerance. The consultant I last saw is aware. He also described the Medtronic model you and I have as being quite new, but that's not the case with the MyCareLink monitor using NFC for reading data. It also uses Vodafone for network access which is patchy here.

I don't know the year of release of our device, but mine was implanted 2016, and in computing power available in a pacemaker, that's a long time. I don't think an 8-year old phone would be described as state of the art, though thankfully, pacemakers aren’t driven by “must have”.

The tech did say I'd get new software, but that goes without saying. I can't see that ectopic are too much of a challenge.

He confirmed 100% dependency in both chambers - I didn't expect that to improve, that's gone never to return.

I'm certainly not keen on the idea of a leadless device and there is no case for it. I just don't like the thought of something inaccessible relying on skilful tethering.

One thing is for certain that in maybe 12 months, all being well, I'll be heading for RSCH.

I didn't realise you were 100% dependent in both chambers

by Gemita - 2024-07-13 15:13:18

Wow Piglet, you have been doing your homework.  Thank you for all that information.  It looks, according to my manual that our pacemakers were probably new around October 2013, the date on my Reference Manual.  My implant was in 2018, so they certainly didn’t give me a spanking new model, did they and nor you!

What surprises me is that you are now 100% dependent in both chambers.  I wonder if this was the reason why you were getting so many ectopic beats while your heart was “slowly” transferring dependency onto your pacemaker?  That middle stage when our heart function changes and becomes more dependent say in heart block or with sinus node dysfunction is the period when we might expect more in the way of ectopic beats to surface, to try to compensate for the loss of heart function.  That is what would happen naturally without our pacemaker.  We would be getting ectopic beats firing in all areas to compensate, to try to maintain a decent heart rate.  

Now that I am 100% dependent on my atrial pacemaker, my heart is quieter than it has ever been until my ventricular lead starts to fire and then my heart throws out unwelcome PVCs.  

I really hope your ectopic beats stay away.  Something is clearly working (100% dependency and steady pacing)?   I wonder how low you can get the Bisoprolol down to before you would experience any worsening symptoms?  It is possible of course that the Bisoprolol has made your dependency more complete by slowing conduction through the AV Node, so reducing the dose might result in a fall in those 100% pacing figures and this in turn might trigger worsening ectopics again, but who knows.  Clearly complete dependency and steady pacing seem to suit you at the moment, so whatever you do, please do it gradually