P/M router

Newbie (82 years) … some of the posts give information that I don't follow. However, here's my situation:

A couple of years ago it was found that I had aortic stenosis and I was given a new (non metallic) valve. All went OK.

I've been on a 2.5 mg diuretic (Benza-something or other) and 20 mg Simvastatin for quite a few years. This was because of high b/p ... this high b/p is under control.

Because of a heart flutter I was put on Apixaban (2 x 5mg daily) about a year ago.

Passed out a couple of times and it was decided that because of a fluttering, slow pulse and the fainting I should have a p/m. This was fitted some days ago. The soreness is wearing off and the dressing has been removed.

The p/m details are: 

ESSENTIO MRI DR Pacemaker 

the leads are

INGEVITY MRI (Atrial) 7741 52 cm

and

INGEVITY MRI (Ventricular) 7742 59 cm

I suppose this is a standard model … (?)

However, I'm wondering about the router that I've been given. It's up and running, with its green dongle-light flashing and the green light on the router green and steady.

What I'm wondering is this:

(1) Where are these reading going? Are they going to my local hospital? Or to some NHS centre somewhere?

(2) Some years ago, my late mother had a p/m fitted (she lived to 102). It was a stumble that proved fatal – not the p/m. But she went to the local hospital once a year for the readings on the p/m to be downloaded by a technician. Does my router obviate the need for such routine visits?

(3) If I go abroad for a lengthy period can I take the router with me? I see there are little switches that can be adjusted to give access in various countries. Would it work in other countries? Is it possible for the readings to be transmitted back to the UK?

(4) Is it likely that now that I have a p/m, I will in due course be taken off the Apixaban?

Thanks in advance for comments.

M-F-H

 

 


3 Comments

Hope this helps until we get responses from Boston Scientific folks

by Gemita - 2020-07-04 15:07:38

Hello My-Foolish-Heart,

I agree, I also find many posts here hard to follow because anything heart related and electrical in nature is a challenge for me too.  But we have to start somewhere and this is a good place.

It looks like you have a dual chamber pacemaker, one lead going into the right atrium, one lead going into the right ventricle and your pacemaker is a Boston Scientific Essentio which appears to be MRI safe if ever you need to be scanned.  I have a Medtronic pacemaker but there are many on this site with a Boston Scientific who will be able to help you.

To answer your questions as far as I can:

My understanding (from my experience with Medtronic monitoring) is that these readings are going to your clinic who will be monitoring your progress.  Many hospitals are now remotely monitoring many patients for any events, although I am still required to go to the pacemaker clinic for an annual check and data downloads.  I believe this still needs to be done annually for most of us although clearly with these remote monitors it will cut the number of times we have to go to visit our pacemaker clinic because our doctors will be able to see what is going on without needing to see us.  Then if anything concerning is spotted, you would be contacted by your doctors for a medication change or pacemaker setting change.

If you go abroad you can take the monitor with you but it may be rather cumbersome.  Speak with your team if you are going for shorter vacations 2-3 weeks.  It may be that they are happy for you to leave the monitor at home and resume daily downloads (or monthly, quarterly or whatever is required) when you return home.  After all if anything happens when you are abroad, you would need to go to the nearest hospital in any case and they could interrogate your pacemaker.  Yes your monitor should work in many countries.  I took my Medtronic several times on European trips and just plugged in to a power point and had no difficulties transmitting data back to London, but your clinic should be able to give you this sort of information.  I attach a link which might be helpful 

https://www.heartrhythmalliance.org/aa/uk/remote-monitoring

Unfortunately having a pacemaker will not stop an arrhythmia like Atrial Flutter (if that is what you have?) and so the need for an anticoagulant like Apixaban will still be necessary for many of us, but you should speak to your doctor about your individual requirement.  I note you have a non metallic valve.  It only takes a short run of an arrhythmia like Atrial Flutter or Atrial Fibrillation to put us at considerable risk for a stroke if we have sufficient risk factors, like older age, hypertension, ischaemic heart disease.  Your doctors will tell you whether Apixaban is necessary lifelong. Apixaban is one of the safest of the newer anticoagulants I believe, with fewer side effects and a good safety profile with regards bleeding risk.

Answers...

by crustyg - 2020-07-04 19:32:54

Your Latitude Communicator was configured to connect to the EP centre that provided it it to you, which won't necessarily be the team that actually gave you the box.  The software at their end highlights any problems, or if you've had a patient-initiated transmission authorised the team will be on the lookout for your data.  Where exactly?  Chances are it's the nearest big hospital - not a District General, but it might be.  Where I am, it's Southampton General, but I *think* Bournemouth also has a receiving centre, but not Winchester or Basingstoke.  The Latitude Communicator only sends up alarms (with relevant data) and doesn't normally send up the usual monitoring electrophysiology stuff like lead impedances and thresholds, AFAIK, but probably could.  It's a balance between overloading the remote monitoring team and missing something important.  If your battery starts to run down quickly this will be sent up.  So, No, you should still be seen once every year or so for a more comprehensive review.

You will be aware that there's a big button in the middle of the Latitude that allows you to initiate an upload - but, again AFAIK, this is not normally enabled unless your EP team has agreed and authorised an upload, otherwise the Latitude will show an error light.

BostonSci are pretty relaxed about their manuals - it's not difficult to find the ref manual for your PM and the Latitude Communicator if you want to read more.

Yes, you can take the Latitude with you - the DIP switches are for different cell-services as you move around the world (not needed if you also have an Ethernet adaptor), *but* they don't change the routine interrogation time, so if you plan on staying for 3months 12 timezones away you should consider asking your EP team to change the interrogation time - requires a clinic visit.

The Apixaban is to reduce your risk of stroke.  Have a look at CHA2DS2-VASc score for more detail.  Chances are you will need to stay on the Apixaban.  It's proven to have the best safety profile (risk of accidental bleeding versus reducing risk of stroke) of any of the oral anticoagulants, it's easy to take, easy to remember to take and in the UK it's free to seniors.  In the USA it's ruinously expensive unless covered by insurance.

HTH.

Operation of the p/m and its router

by My-Foolish-Heart - 2020-07-05 18:35:01

Thank you both for the detailed and prompt replies. My questions have been answered and I now know what's going on. So if I go abroad (it would be to Europe) the p/m will continue to communicate with the centre at my UK hospital - and not at some local hospital in the locality. But perhaps I should inform the UK hospital in advance and let them know. The little switches on the router are explained in the manual so I'll know the settings for the country concerned.

M-F-H

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