Pacemaker Trade #2

Trade offs

by Theknotguy - 2018-08-13 08:23:53

EP/Cardiologists are like everyone else.  Some are great, some are OK, and some shouldn't be in the profession. 

What you hope for is an EP/Cardiologist who looks at your medical record, looks at your lifestyle, consults with other doctors, then makes a decision as which style of pacemaker will work best for you.  Worst case would be an EP/Cardiologist who looks for the best rebate, looks to see who's brought in the best perks for him and goes that way.  Hopefully you got the former instead of the latter.  And don't forget ethics.  

I volunteer at a large city, big hospital.  Question for most of the EP/Cardiologists there is what will be best for the patient.  What will fit the medical conditions and what will fit the patients lifestyle.  When it's a toss up as to which manufacturer will be the best they rotate through the major brands.  That way if there is a recall on any of the pacemakers it will cause a minimum impact on their patient base.  Oh, and by the way, all pacemaker brands have had a recall at one time or another.  Doctors rotate through the major brands because they don't want to get into a lawsuit in case you have an unforeseen problem with some off brand.  

The 93 year old guy who sits next to me in church has the same brand of pacemaker as I do.  By chance we see the same EP.  His pacemaker is generic - it mostly keeps his heart beating.  My pacemaker has two software programs running on it in addition to it just being a pacemaker.  If we didn't tell you, you wouldn't know we had the same brand of pacemaker.  Both work very well for us.  

There has been some discussion on the forum about which brands will work best for people with very active life styles.  Mostly the discussion has been about how the pacemaker will respond to activity and not about a specific manufacturer.  Looking at old posts on the forum won't help because the medical technology is changing so rapidly.  I had the latest and greatest four years ago, now my pacemaker is considered obsolete.  But it works fine just the same.  Pacemaker manufacturers are changing things all the time and what didn't work well last year may not be true for this year.  

As for what goes through an EP/Cardiologists mind when selecting a pacemaker?  You'd have to ask them.  They've spent years learning what works best for their patients and how they arrive at that decision can get a lot more technical than we can discuss here.  If I had to pay for the time it would take for my EP to tell me how he arrived at his decision I really couldn't afford to pay him.  Besides most of the technical explanation would be just noise as I wouldn't understand the technical jargon anyway.  My pacemaker works fine and I'm getting into discussions as to what will work best for me in the future.

As for differences between the major brands of pacemakers you'd spend a lot of time going into very technical details.  You have the mechanical side but when you add in the software side it's almost impossible to explain all the combinations and permutations that will make a pacemaker fit a specific individual.  

I hope you have a good fit on your pacemaker and things are going well for you.  
 

Type of pacemaker- some aspects of choice.

by Selwyn - 2018-08-13 12:58:58

Here in the NHS decisions are based on clinical need, value for money, and what the department has been geared up for, and  patient views / lifestyle.  Personal experience is paramount.  Clearly other financial factors come into being with private medicine. 

It is not just a matter of choosing a pacemaker to suit the individual.  Hospital department issues of hardware provision and training have to be considered. 

Cardiologists will favour devices they are familiar with.  Published medical journal papers may influence choice, as may attendance at medical meeting, talking to colleagues, and taking note of the deparment of health/NICE guidelines, and personal experience. 

In general, the patient's best interest is put first, however sometimes this needs to be modified in the light of reality (such as government contraints). 

If only we could all drive around in a Rolls-Royce!

The choice situation is multifactorial. If you really want to be fitted with a device no one, including your cardiologist,  is familiar with, become more insistant!

Kind regards,

Selwyn

Best one they can support....

by BOBTHOM - 2018-08-13 22:01:16

My EP selected the best one that the department could support.  One they were familiar with.  I ask beforehand about which one they were planning to use and got a very vague answer.  In my experience, EP's can't learn all the brands and all the models so they focus on one primary and a secondary "favorite" and those are what they will use.  And in general, between the hardware and software options that they all offer each one can be configured to meet your needs.  You just need to keep after them for all the adjustments.  As for the manufacturers, they are usually pretty helpful but will mostly refer you back to your EP who they have trained to use/setup the device properly.  Good luck in finding more info!

dont agree

by dwelch - 2018-08-28 03:40:22

I dont agree that one brand is that much different from another.  And is it three companies or two?  How long before it is just one?

First off, focusing on how they chose the device is a problem, it is not that you got the wrong device but you are worrying about the wrong thing.  The primary thing to worry about is not having a device when you need one.  Once you have one...problem solved...done.\

New devices are like new cars, if only we could get used pacers with new batteries life would be so much better.  Like  new car each brand for a class of vehicle is pretty much the same.  Half ton pickup, you might have percieved preferences but they all do the same job as well as each other.  It is in no way possible to tell that this years model of brand X is going to have any kind of life and quality of prior year models from brand X this could be a bad year.  Same goes for brand Y and brand Z.  My doc and I would hope others rotate around the brands, at least for that reason, if brand X has a bad year then not all of my patients are at risk only a third.  How they work the battery life is basically the same across the brands.  Each brand has different models with different features so you can find a more athletic one or a longer battery life one, single chamber a dual a bi-ventrical.  An icd or not.

Insurance plays a big role in certain areas.  The practice/hospital/whatever can play a big role. 

But again would you rather have your EP spending 90% of their time not in the office test driving every make and model of vehicle every day so that they might very slightly give you one that might be slightly tuned a little better to you than another that would have worked just as well, but because so busy doing that didnt have time to take care of your year to year heath and checkups.  do I get to see the doc this year and talk about my condition and the adjustments you just made?  Nope the doc is too busy reading pacer manuals to have time to spend on you.

You are worrying about the wrong thing. 

Bottom line either you trust your EP to do their job or not, you trust them with your life or you dont.  Unless you are an EP yourself, they are significantly better at it than you are.  Find one you trust then trust the one you found.  If you refuse to trust the doc, then maybe you should just go without a pacer.  Are you going to hand pick the surgeon too?  Choose the brand and model of EKG machine?  Latex gloves?  Where does it end?  It is not possible enough for you to get to their level in the time you need to in order to choose a device.  They are all the same I know from experience they can plop in a different brand use the settings from the prior brand and other than the recovery from surgery you dont notice a difference.

Update

by Dakotamick - 2018-09-17 09:28:34

I've done quite a bit of research and investigation into why one or another pacemaker is the better or preferred for a category of recipient.  Ignoring the specifications which are way beyond the intent of the this trade, there are 3 general features which are appropriate to trade 1) type of pacemaker (3 types), 2) analytics and analysis available by the manufacturer, and 3) technical support to the doctor and or patient.  In terms of types of pacemaker, the 3 major pacemaker companies appear to gravitate to one of the 3 categories.  It is clear that one of the three pacemaker companies provide analytics and visualization to aid in accurate and fast diagnostics as well as how well the device is performing.  The last is support, while a doctor may be well versed in pacemaker technology, it is the manufacture representative which can aid the doctor and patient in understanding the details of the unit, coupled with being local and on site is a big difference.  If anyone is interested, I can dive into more details but will leave it here for now.