Bi-V Defib vs. Subcutaneous Defib

Both?

by Cabg Patch - 2016-10-05 17:15:20

If you already have a 3 lead device (CRT or Bi-Ventricular device ) then that means you are paced. As I'm sure you must know, an S-ICD has no pacing capabiltiy. Are you saying you would have both an S-ICD and a Pacer ? If so...I think that would be a bad choice, very bad choice. The S-ICD could detect functioning of the Pacer as an arrhythmia and could quite possibly give inappropriate shocks. As it is, my CRT-D detects PVCs as normal beats and the pacing function doesn't work quite the way I actually need...these are fabulous devices but not the smartest.

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-06 11:39:52

Thanks. I have an appointment with the surgeon to provide clarity and make a decision. He seemed to be leaning toward the S-ICD "add-on" to minimize chances of infection. I have not been able to find enough info on the internet to help me make a decision. Thanks for the reply.

Yes, Clarity is definitely needed

by Grateful Heart - 2016-10-06 13:03:02

Something doesn't sound right.  Like Patch said, the S-ICD will not provide pacing. 

Ask a lot of questions.

Grateful Heart

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-06 13:11:23

As has been pointed out, I am already paced. They just want me to have a defib. Whether it is on my side or in my chest seems to be up to me. I keep hoping someone will read this pot that has had to address this situation. Thanks!

You won't find anyone who has both

by Grateful Heart - 2016-10-06 13:22:33

At least not both that are activated.

That's what we are trying to tell you.  They can implant a 3 lead with a defib as you stated.....or deactive it and give you a S-ICD....defib only.

So....if you need to be paced (as you already are).....then it's a 3 lead with a defib.

We don't know your medical situation so that's why you should ask questions. 

Again, something doesn't sound right.  Just trying to help.

Grateful Heart 

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-06 13:28:56

What you say makes complete sense to me, and though I am hard of hearing and could have misheard, my wife heard the same thing. This is why we are seeing the surgeon before the scheduled surgery date.(25th) What I promise to do is post the result of my consultation on the 19th. Thanks again!

Good Luck

by Grateful Heart - 2016-10-06 13:32:44

Yes, please let us know.

Grateful Heart

Remember

by Cabg Patch - 2016-10-06 15:30:29

Remember...

All they would need do is replace your current bi-ventricular device with a bi-ventricular defibrillator. Basically just like changing out the "battery" slice, swap and good to go. You would have all functions in one unit and not risk of interference.

Going with both, I believe there would be issues but also you would have to worry about monitoring two devices as well as changing two separate units out when the batteries need replacement. Wonder how your insurance would like that, twice the cost, twice the risk.

Frankly sounds crazy to me...but who am I

Good luck whatever you decide on.

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-06 15:54:30

That is kind of my thinking too, except the surgeon said he would have to replace one of the 3 leads. I don't know which one or why, but that is what he said. Perhaps he is planning to "McGyver" the whole thing, who knows?  :-}  We shall see on the 19th.

Right Ventricular Lead

by Grateful Heart - 2016-10-06 18:19:03

He'll replace the RV lead with a defib lead.  Most likely will just cap off the old lead and insert the defib lead if your vein has room. 

It's something they do all the time.  Much easier than removing the old lead.

Grateful Heart   

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-06 18:30:17

That sounds entirety acceptable to me!

Bi-V Defib vs SubQ

by alex.rivera - 2016-10-11 13:02:31

It sounds like the best bet right now is to get more information on the 19th and make some choices.  That said, here's what I can say about my experience.

I was going from a 2 lead pacer to a 3 lead, bi-v/ICD.  I was not told of the possibility of a subQ until after the replacement surgery.  The doctors only wanted to explore the subQ route if they could not get the 3 lead, bi-v/ICD functioning smoothly (mine is placed relatively close to my diaphragm and can cause contractions under certain configs).

I think the reason why subQ was not on the table originally is because it is a more invasive, but I would have to ask to confirm that.

A few other questions I might also ask that have not come up are: what are the recovery differences?  what, if any, device efficiency differences exist?

-Alex

Bi-V Defib vs. Subcutaneous Defib

by general3651@gmail.com - 2016-10-11 13:15:44

The idea of the "add-on" defib was presented to me as a LESS invasive, shorter recovery than the total unit replacement. It makes sense, but unless he talks me out of it next week, I am liking the replacement option.

Decision made

by general3651@gmail.com - 2016-10-24 12:32:27

I told my surgeon that I wanted the Bi-v instead of the subcutaneous and he simply asked why. I was pleased to be able to answer him with facts gleaned mostly from published medical papers on the subject. I told him of my concerns with: 1) Lead for sensing and shocking is much further away(obviously) than a Bi-V   2)It takes more current to shock    3)It takes longer to detect problems    4)It takes longer to recharge the capacitor.   I was saving the fact that I do not want 2 devices in case he tried to convince me otherwise, but it was not needed. The only downsides have been that I have to go for a venogram, which is no big deal, but they postponed my surgery until November 22nd because they say there has to be a surgical team ready to repair the vein if they tear it during the extraction. The upside to surgey right before Thanksgiving is that for one time I will not have to smoke and fry turkeys for Thanksgiving.I will post again afterwards. Thanks for all of the replies.