Frequency of in-office Pacemaker Interrogation

I have had a Pacemaker since 2006 (now on my second one, implanted in 2016.)  Initially, I was seen by the nurse for an in-person annual pacemaker interrogation with scheduled remote transmissions in between for many years.  Then around five years ago, they stopped seeing me in the office entirely.  I do intermittent remote pacemaker transmissions and never see a nurse, technician, or doctor.  How common is this for the rest of you?  Are you typically seen for an office interrogation at least once a year?  (I do understand there are numerous variables impacting frequency related to clinical conditions and pathology, etc.)  

Thank you for any feedback you can share with me.


16 Comments

Frequency

by Lavender - 2023-07-23 19:41:26

Every three months, my pacemaker has a check. There are alternate in office and at home checks. I'm seen in office with a pacemaker rep interrogating. Then three months later, an overnight automatic transmission is done. Three months later, I am inperson at the cardio office. Repeat. So I am in office every six months. 

Thank you!

by mchokozi - 2023-07-23 19:44:35

Wow!  That is such a contrast to my management.  I have received coverage through a Health Maintenance Organization known for minimalist coverage, which may be relevant.  I will switch to a different health plan soon to see if anything changes with that transition.  

Thank you so much for sharing the details of your care.

how often i am seen

by new to pace.... - 2023-07-23 21:22:48

For me have nightly transmissions, do not feel them  Then quartely transmissions(was told) that was so Medicare  could be charged and would pay them. Also they charge Medicare to read and they can paid again. Then once a year in office pacemaker check moved it to the anniversary of the implant of the pacemaker.  Made more sense to me to have it done then.  Also once i year i see the caridologist.

new to pace

 

Thank you also

by mchokozi - 2023-07-23 23:16:22

Thank you for sharing the details of your care.  Understanding the care regimen other people with pacemakers may experience is very helpful.  It sounds like you are receiving excellent care!  Thanks again!

 

Frequency

by piglet22 - 2023-07-24 06:44:07

I know it's strictly not relevent to your situation, but in the UK, in my region at least, routine face to face appointments stopped about three years ago.

It's now almost entirely remote. So much so, they refer to them as Virtual Device Clinics.

I miss the in person clinics and what makes it particularly bad is that you get a monitor through the post and that's pretty much that. Although I can read instructions, it's surprising that the hospital never checks that you are OK with the remote monitor

You might get a letter once a year asking you to do a transmission manually, they phone you back 30-mimnutes later "pacemaker working fine" and that's it for another 12 months.

If the monitor (Medtronic MyCareLink) does send out automatic transmissions, then no-one gets back to you. The monitor shows the date of the last transmission and it's always the date of the manually instigated transmission.

Apart from one rate adjustment, I haven't seen anyone in person for the last three years.

Personally, I think it;s bad for patients and it's bad for the clinical staff who don't get to see their patients.

There must be a lot of people who don't or can't access groups like this and are left to get on with things without much support.

Remarkable!

by mchokozi - 2023-07-24 08:07:38

Thank you so much for sharing your experience with the UK system in your area.  That seems more consistent with my experience to some degree.  The only difference is that I do remote transmissions every three months but do not receive any feedback unless I call to request information regarding the findings. However, like you, there has been no in-person interrogation of any kind, nor contact with a nurse or tech (let alone a doctor.)

As you approach the end of your battery life, will they increase the frequency of remote transmission to ensure you are changed out in a timely fashion? 

Yes, I agree groups like this are very helpful in framing a larger picture of a given question or situation.  

Take care.

Frequency

by Aberdeen - 2023-07-24 09:42:17

I have a pacemaker check up annually at the pacemaker clinic at my local hospital. I also have an annual echocardiogram. I live in Scotland. This is on the NHS.

checks

by Tracey_E - 2023-07-24 10:12:35

Mine used to do a remote reading every 3 months but I'm getting into the last year so it's every month now. I go in person for interrogation and check up once a year, which includes seeing the ep, xray, echo, and every other year holter and stress test. Is the pacing clinic separate from your doctor follow ups? If it is, sometimes we slip between the cracks and they forget we need to be seen also. 

Frequency of pacemaker interrogation

by Gemita - 2023-07-24 10:14:33

Mchokozi, thank you for your post.  Frequency of in-clinic pacemaker interrogation will depend on many factors and whether we have any symptoms.  Having symptoms tells us and our doctors that something may be wrong, whereas wihout symptoms we might go for lengthy periods without being seen.   As you say, frequency of follow up will depend on our need.  For example whether we have arrhythmias that may be affecting our pacing and settings adjustments are necessary;  whether we need our settings changed due to lifestyle changes, for example for those members who need adjustments of settings to enable them to carry out their particular exercise routine;  whether our settings need adjusting as a result of changes in our heart condition or medication;  whether our battery needs replacing which will need more frequent follow up.  So much can affect our need for follow up.

Since I have arrhythmias, I have been going back frequently to my clinic recently (every 3 months) for settings adjustments, but once my settings and arrhythmias are stabilised, I will only need to return every 12 months for a complete check up until I get nearer to battery depletion, when obviously check ups would become more frequent.  I only see my EP on an as needed basis (for example when I have a change in my heart condition or worsening arrhythmias and might need a medication change or other treatment like an ablation for Atrial Fibrillation).

I have home monitoring but only do remote transmissions on an as needed basis now, not routinely, nor am I monitored automatically any more (it used to be nightly) since my arrhythmias are well controlled and my in person clinic visits are still frequent and I prefer it this way.  Despite a failing NHS service in the UK, my care in a main London Hospital is excellent but I am very fortunate and this is certainly not the norm anymore.

My husband is also paced, single lead to right ventricle.  He now (after 4+ years) has home monitoring to watch his non sustained ventricular tachycardia episodes.  He also has regular in-clinic appointments (every 6 months) and he too receives excellent support from a main London NHS hospital. 

In-office is less common, and becoming more so, I think.

by crustyg - 2023-07-24 11:21:35

I have an under-the-bed monitor which connects to my PM every night - very briefly - and *if* there are any alerts then forwards the information to BostonSci => and eventually the EP-techs.  By prior arrangement I can manually initiate an on-demand upload.

My annual in-person visits are to be replaced, from the next one, with just a remote transmission.  When I asked about how I would receive my copy of the reports the EP-techs said 'we'll email them to you if that's OK?'.  Not secure email, but not a major issue.

I was on a professional 'Restarting Cardiac services' call some time ago, as the Covid-19 lockdown madness was ebbing away and a very large English Teaching Hospital were admitting that they'd been pulling all of their patients into the hospital as they hadn't done anything to set up and use remote monitoring.  I nearly fell off my chair.  Where I am they are much more organised.  *But* having said that, when I asked about one tiny aspect of my device at my last in-person, they said 'Oh we'll set you up so that Event is always forwarded to us if it happens.'  Not completely reassuring, since I've had one and it was missed.

Using remote consultations and remote monitoring has its place, both to save time/money for the healthcare system but *also* for the patients - it can be really expensive to flog into a hospital scores/hundreds of miles away.  Whether it's the right thing to do is a judgement call - for simple cases like me, it's an easy decision.  For others, in-person may be much more appropriate and worth the costs, on both sides.

 

Thank you for the many helpful responses

by mchokozi - 2023-07-24 13:18:25

@Aberdeen, it is interesting that the NHS in Scotland provides you with an annual in-person as your local hospital's Pacemaker Clinic.  The annual echo likely would be a follow-up regarding valvular, systolic, or diastolic status (or some combination of these functional aspects.)   

Someone else from the UK (perhaps within England proper) had indicated a practice shift to exclusively Virtual Device Clinics, so there may be a practice variance within the NHS.  

@Tracy_E, your management sounds quite comprehensive.  I do know that when there is documented cardiovascular disease (in addition to exclusively an arrhythmia), the pattern of performing diagnostics can be more frequent and involved.  It sounds like your management plan is well-integrated and thorough, so I am happy for you. It is nice they are monitoring you with such caution as you approach the end of your battery life.

(A Cardiologist does not see me, as I only have an arrhythmia issue of Cardioneurogenic Syncope not associated with cardiovascular disease.) However, I was previously seen annually for in-person interrogations, but that has not happened for a long time, as I mentioned in my original post.)

@ Gemita, thank you for your in-depth description of pertinent variables and the pattern of care you receive.  From what others have shared in this thread, it sounds like a wide range of patient management in the NHS.  I am so happy that you and your husband receive exceptional and highly attentive care and follow-up.  

@ Crustyg I appreciate your analysis of aspects impacting monitoring patterns.  I would share your concern regarding the one that was missed.  Certainly, remote monitoring is a net cost savings for patients and the healthcare system in many cases.  However, I agree it is nuanced, given the individual in question, and the best practice may shift based on the type of arrhythmias requiring monitoring (e.g., episodes of Ventricular Tachycardia controlled by an implantable Pacemaker/AICD combo.) 





 

Echocardiogram

by Aberdeen - 2023-07-24 14:06:34

Mchokozi,

I should have mentioned that I get an annual echocardiogram as I have a mitral valve prolapse. 
It was interesting to read everyone's varying experiences with pacemaker care.

Thanks again

by mchokozi - 2023-07-24 15:24:10

Yes, it certainly is interesting to hear everyone's experiences.  That is great you receive annual echo monitoring.  Take care.

Thank you Mchokozi!

by Aberdeen - 2023-07-24 16:18:22

Thank you! 
You too!

Kaiser Permanente HMO

by Stache - 2023-07-26 00:31:11

I belong to Kaiser in Northern California.  I have a 3rd-degree heart block with a dual chamber pacer and home monitor. I can access my medical records online now.  This is a major change and great for me to have access to my full medical records.

I have in hospital pacer checked twice a year. I am going in on August 1st for my next pacer check after my pacer setting were changed a few months ago.  If my monitor indicates an issue the pacer office monitor with schedule a pacer visit.  Almost everything is done online now and I have direct messaging to my doctors.  This is way better than three years ago.

@ Stache

by mchokozi - 2023-07-26 00:45:13

Hi @ Stache,

Thank you for sharing your history and experience with Kaiser.  I also have belonged to a Kaiser HMO in Northern California since 2007. (I will switch to a different healthcare provider next month due to a job change.)

Like you, I enjoy their healthcare portal in terms of messaging providers and accessing records and the like. However, I have only received the findings posted to the portal on a single occasion over many years. 

Sometimes, I have received a call indicating the remote transmission was received, but usually, there is no communication (likely reflecting the stable functioning of my pacemaker.)

That is fascinating they perform in-hospital checks of your pacer function twice a year.  I am so happy to hear they are monitoring you closely and that you are having a good experience with them.  

Take care.

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