Choosing the implant physician

I have problems with exercising (I have a recent post entitled "Chronotropic Incompetence"). I am asking for some advice on how to go about choosing a doctor to implant a PM. I started with an interventional cardio. who was very open minded in sending me to an EP. It took a couple of years to reach the diagnosis that a PM is what I need. Should I use an EP or the interventional cardio? Should I base my decision also on the device manufacturer used? To complicate things I just read an article from the NY times which is reproduced on this site ("Growing Debate as Doctors Train on New Devices"). The interventional cardiologists reported on here are the ones that I am seeing!!! For those of you not familiar with this article the devices here are ICD's not PM's and the implication is that some manufacturers are stimulating sales by providing training. I am not necessarily swayed by the article but I'd like to hear if there is a general consensus on choosing an EP and not an Interventional and the number of implants done per year. Comments?

7 Comments

My opinion

by bowlrbob - 2007-06-11 09:06:49

My opinion only but I would go with the EP. Just as the previous post said they do 100's a year and they have studied the ins and outs of the workings of the PM. Everyone needs to have them fine tuned to whatever needs they might have. My EP was awesome and later i was sent to a heart surgeon and he had no idea what to do for me. So I went back to my EP and with his adjustments fixed me right up. Bowlrbob

EP

by hooimom - 2007-06-11 10:06:50

I had an interventional cardiologist look at my test results and say I didn't need a PM but sent me to the EP just to "make sure". The EP took one look at the same test results and said I needed a PM and not to wait too long. A week later I had a PM. An EP is a cardiologist specializing in the electrical systems of the heart so if that is your problem, I would use an EP. Although the cardiology group offered to set me up with follow up appointments with the cardiologist who originally didn't think I needed the PM (gee thanks), I chose to stay with the EP who did my surgery. I think it's a good idea to have an EP you trust to do the surgery and can communicate with for follow ups. It means a 2 hour drive instead of 20 minutes, but it is well worth it to have someone with lots of PM experience. Let us know how you are doing.

Michelle

Not impressed with EP's I've seen

by axg9504 - 2007-06-12 08:06:09

I'm generally not impressed with the EP's I have seen (2). I was incorrectly assessed as having Afib by the first and the second did an ablation for a flutter that showed up during an EP pacing study. No one has given me an opinion yet on why exercise not only induces bradycardia but causes me to stay in it for long after the exercise. Maybe there's no answer. I believe both EP's and Interventionals have the experience needed to insert the leads. It's the choice of the implant and whether they know how to fine tune that's the question. Do I just ask them how many implants they've done?

I read about Guidant and would not have one based on what they did. I need a PM that has good rate response. Based on my heart monitoring, my BPM needs to be at 75-80 when just resting, 90-100 when I'm walking, about 140 at a 10 mt pace and then it needs to stay at 100-110 for several minutes after I stop running. Can a PM do all this smoothly? Is it possible that it can induce some other arrhythmias if the incorrect PM is chosen or if it's not tuned correctly? Thanks for any comments on what q's to ask the EP about choosing a device.

hooimom

by axg9504 - 2007-06-12 08:06:22

Would you mind telling me a bit more about your situation? what test did you have and what results prompted the EP to put a PM in you right away? thanks

Sure!

by hooimom - 2007-06-13 05:06:52

I had been very short of breath for almost 2 years but had been told I had asthma. I finally switched to a new PCP and she didn't think it was asthma since none of the asthma meds was working and I had never had asthma before. She ordered a echocardiagram and a holter monitor. The echo looked great but I got a call from the cardiologists office where I had the tests done and they scheduled an appointment for the next morning. It turns out my heart was stopping regularly at night while I was sleeping. Nothing much happened during the day so I wasn't having fainting spells but I did have some dizziness and the shortness of breath. The first cardiologist in the group said you need a PM probably but lets do a stress test. He was moving out of state so set me up with another doctor in that group. The new doctor looked at my stress test and said he didn't think it was so bad. When I asked him why I couldn't breathe, he said I hadn't conditioned my heart (which is hard to do when you can't BREATHE). He did send me off the the EP in Orlando just to make sure. She took one look at all the test results and said not only was my heart stopping at night but the atria and ventricle were not in sync and the ventricle was not pumping correctly because of the mistiming. That was causing the shortness or breath and dizziness. She felt strongly that my problems would lead to fainting soon and that the PM was the only safe option. My mom is a cardiac nurse and my stepdad is a PA and they were both in agreement that my AV block would get worse and could be dangerous. I chose to get the PM. Because I had three weeks between first hearing the word PM from the first doctor until the time they worked my in with the EP I was ready to get it over with. The EP was great. She scheduled me for six days later. I just didn't want it hanging over my head for a long time. I was very happy with my doctor and I choose to travel to Orlando to see her for my check ups. I was at Florida Hospital Orlando which is one of the top rated cardiac centers in the country. She had a lot of experience, she spent two hours going over the surgery and PM with my husband and I. She talked to me about my children and whether they might have the same problem. She asked me if I had a preference of pacemakers (what did I know back then). I let her choose and I have a Medtronic dual lead. It paces my atria and the ventricle follows nicely most of the time.

You will find that after the PM is implanted some doctors seem to think you are fine and don't understand the adjustment a lot of us go through. That was a little frustrating at the time, but she doesn't have a PM so how can she understand. You have to find a doctor you can talk to who will listen to you. You will know when you find the doctor for you. We are all looking for different things. Some people only want the skilled doctor and don't care about the bedside manner. I want the skill but I have to have a doctor I can talk to. Decide what is important to you and find that in a doctor.

Let me know how it goes.
Michelle

Hooimom

by axg9504 - 2007-06-22 08:06:24

Sorry, didn't log on for a while. What I think is unique about my situation, well maybe, is that my problems are always triggered by exercise or some exertion. 4 years ago it required about 10 mts of jogging, now it could be pushing a drop spreader across the yard. My heart rate gets irregular, I have all the symptoms of PVC's (which I have sporadically at rest too, with no side effects) and then my rate won't keep up with what's required. I can now walk for about 30 mts at 4 mph, my rate is around 100 when it needs to be 120 or so, I'm out of breath and it is tiring. The fun starts after I stop exercising, my rate will go down to the 60's almost immediately. I'll get dizzy if I try to climb steps or stand up after sitting. Usually this will clear up after 3-4 hours and my rate will be back to the high 70's. Sometimes it goes on for 12-24 hours. Sometimes like yesterday night, when I did my usual 2 mile walk, it recovers and I wake up early morning with my heart pounding (I really feel it when it gets below 40). That's what happened at 4:30 this morning and it's now 7:00 and I still haven't recovered. My rate will go up to 60-70 when I walk around.

I've had all the tests, catheter, trans eee (I have something called a PFO), echo of my carotids, the final diagnosis is I think with some kind of sinus node disorder. Docs slowly gravitated towards the prescription of a PM. They've left it to me to decide. I've decided to check out another clinic locally that has very extensive experience in the area.

I can't believe they didn't give you a breathing test to check for asthma. My EP did send me to a lung doctor to check out my lung capacity. There is something called exercise induced asthma that some world class athletes have.

I don't care about bedside manner, I'd rather have a Dr. House MD. I pay attention to how a doc. makes his decisions and so far I'm not satisfied.

Choosing Implant Physician

by fenix - 2007-09-15 05:09:21

I would get references from your friends/neighbors/acquaintencesl

Also, if possible, find one closer to home because subsequently you will have office appointments every six months with the EP.

I eventually selected the head of electrophysiology at the local hospital which is large. Also talked to two people who had implants by this EP. I am happy with the results (implant was done 16 mos ago).

Before implant talked to Medtronic trying to zero in on the type of PM. Had good information. However at the last minute I allowed PM to select the PM as he knew my lifestyle.

He selected Guidant. So far it works quite well, had no problems.

But if I would do it again I would not select Guidant, because the sales/technical rep did not adjust my PM in the hospital and was not willing to help later. My letters to the Guidant President were completely ignored.

More recently my PM model was on recall list, but, fortunately I do not have difficulties with it.

By the way Medtronic has many offices throughout the country and overseas which apparently can help adjust the PM if needed. You can find this on the internet.

Above all, make sure that you actually need a pacemeker.

You know you're wired when...

You always have something close to your heart.

Member Quotes

It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.