Best CRT device

[Anonymous]

I am a pharma rep. w/post partum cardiomyopathy. I got my first BS CRT device 6 years ago and have to have it replaced. I went online to try and find out what the best device is because my EP only uses BS and I want to make sure that I am getting the best one available and can only find product info. for each companies own product. Are there comparison studies or where do I find the research behind each of these devices so I can make a comparison.

Thanks!

 

[Anonymous]

This isn't the greatest place to come for actual medical device but I believe that all of the CRM vendors have good crt technology. The real question especially for most patients should be device longevity. There is one company that has a black eye when it comes to longevity and it is unfortunately Medtronic. The best longevity according to a recent independent analysis of the four crt-d manufacturers was: 1) Biotronik, 2) BSC 3) St. Jude (which were all respectable). MDT was much worse. See the attached link.

http://ondemand.hrsonline.org/common/presentation-detail.aspx/15/35/1241/9000

Also, your new device will most likely have a much different shape and size no matter which manufacturer is used for your surgery. Ask your physician for plastic demo devices which he might consider using. Good luck.

 

[Anonymous]

Are you responding to the device you have now? Are you breathing better, EF stable, less fluid, more exercise tolerance? If so, the therapy is working for you. BSX device should be fine for you. If you are not responding, and your intrinsic conduction is less than 230ms, you may want to try adaptive CRT therapy from MDT. This does not apply to bi-v pacemakers. Just ICDs.

 

[Anonymous]

Are you responding to the device you have now? Are you breathing better, EF stable, less fluid, more exercise tolerance? If so, the therapy is working for you. BSX device should be fine for you. If you are not responding, and your intrinsic conduction is less than 230ms, you may want to try adaptive CRT therapy from MDT. This does not apply to bi-v pacemakers. Just ICDs.

I had no symptoms prior to being diagnosed..none whatsoever. Exercised 6X a week and in great shape. My EF went from 20% to 60% so yes, it is working and yes it is a bi-v pacemaker. I felt great before it was implanted and now I have to take a nap every day because I am so tired between 12-1. They tried to optimize the setting more then once. I am wondering if it could be pacemaker syndrome?

 

[Anonymous]

Pacemaker syndrome is when there is no atrial lead. The atria contract against the ventricles rather than in sync. You probably don't have that condition.

Congrats on the 60% EF. You got originally for post partum. Maybe being a mom tires you out. LOL.

I see patients focus on their devices when it does not have anything to do with the device. We slow down as we age. Sometimes it is not the device. I would not give it much more thought. Tired between 12-1 is not a device thing IMHO.

 

[Anonymous]

Actually Adaptive CRT is available in the CRT pacemaker. It is called Viva CRT-P. It is not nationally launched but is easily available upon request and FDA approved. That would be the best device for you.

 

[Anonymous]

How can you make a blind statement like that? You have no idea if the OP conducts normally. Also, an FDA exception would have to be made. How would you prove this is clinically necessary? She has responded to her current therapy.

 

[Anonymous]

The adaptive bi v ppm is already FDA approved. No exception would have to be made.

 

[Anonymous]

Here is a thought, maybe since your EF is up you no longer need a device. Ask your doctor.

 

[Anonymous]

I was a candidate for CRT when I was diagnosed with ventricular dysynchrony -level 1. I had no symptoms prior to implantation..not even out of breath when exercising or climbing stairs and that was with a 20% EF. And now I need to take a nap every day? Something is wrong and no one can figure it out. Yes, the most important thing is that my EF is normal but they won't take the device out because they don't know if my conduction problem will return without the device. And if it does, they can't promise that CRT will work the second time around. I am scheduled for a new device tomorrow and that is why I was wondering if one device was better then another. No Dr. has been able to help me so that is why I thought I would give CF a try in hopes that a rep. might have dealt with other patients with my problem.

I appreciate the insight and feedback. Unfortunately ,there is no time to look into any of the newest devices as was suggested. One would hope that my Dr. knows about them????

 

[Anonymous]

I just looked up the adaptive CRT therapy that was just mentioned and without going into detail, this sounds like what my issue was originally. I wish there was someone that I could talk to! When implanted I was so tired I couldn't function for 3 weeks!! I finally convinced the Dr. that the timing was wrong and he did a ECHO and agreed that it was and did some adjustments and I got about 75% better. But was still fatigued. I copied info. from your website (see below) and the VIVA XT sounds like it is ideal for someone who has an issue with the device not being optimized correctly. If this was a problem the first time around, is it likely to happen again with a new device??


Overview
CardioSync™ Optimization, a unique in-office programmer-based algorithm, provides suggested optimized CRT settings to help reduce loss of BiV pacing due to inappropriate AV/VV programming. The CardioSync Optimization Test measures the patient’s intrinsic AV intervals and P and QRS waveform widths. Based on the measurements, the test provides optimized values for the following CRT parameters: V. Pacing configuration, V-V Pace Delay, Paced AV, and Sensed AV. These calculations are comparable to the ambulatory measurements performed by AdaptivCRT™, available starting with the Viva™ XT device model.

 

[Anonymous]

Be honest with yourself!! EF of 60% is darn good!! I am a device rep and sounds like you are doing great. Let's look at other things before device. What time of day do you take your meds?? Are you on more than 1 blood pressure med?? Sometimes docs want your BP as low as what is tolerable, not what you feel best at!! What does your BP run?? How is your blood sugar controlled?? Any diabetes or Hx of diabetes? Any over the counter meds or supplements that you take?? Take any meds before lunch time or on an empty stomach before lunch?? Any issues w/ depression? I know it's taboo, but be honest with yourself? Ask family members if your behavior has changed any, they will notice it before you...if the issue continues post device change out, think about some of the things I wrote!!! Good luck!!

 

[Anonymous]

Be honest with yourself!! EF of 60% is darn good!! I am a device rep and sounds like you are doing great. Let's look at other things before device. What time of day do you take your meds?? Are you on more than 1 blood pressure med?? Sometimes docs want your BP as low as what is tolerable, not what you feel best at!! What does your BP run?? How is your blood sugar controlled?? Any diabetes or Hx of diabetes? Any over the counter meds or supplements that you take?? Take any meds before lunch time or on an empty stomach before lunch?? Any issues w/ depression? I know it's taboo, but be honest with yourself? Ask family members if your behavior has changed any, they will notice it before you...if the issue continues post device change out, think about some of the things I wrote!!! Good luck!!

Thanks for the suggestions but all of those bases have been covered.

Clinically, I am doing great but the nap thing is a pain and if it can be fixed while I am getting a new one then I am going to try. One shouldn't feel worse after a device is implanted...it just doesn't make sense.

1. Take my bystolic 5mg (minimum dose) at night
2. My BP is 110/65...I experience some hypotension but nothing can be done with that
3. All blood work done several times and no anemia, diabetes or thyroid problems
4. No other meds or supplements
5. No depression issues-sold an SSRI so I am very familiar with the symptoms and no, no behavior changes according to my husband.


Talked to Dr. and he said the Medtronic device with the adaptive CRT is no better then the BSX device and in fact, they have the same technology. Is that true?

 

[Anonymous]

If you have intrinsic conduction and it is 200 ms or less, adaptive CRT is the best algorithm. Cardio sync is not special. It is the adaptive CRT you want. That is by far the best device today. The Viva XT bi v pacemaker. However, as another poster mentioned, it may not be the device. But you may as well have the best.

 

[Anonymous]

If you have intrinsic conduction and it is 200 ms or less, adaptive CRT is the best algorithm. Cardio sync is not special. It is the adaptive CRT you want. That is by far the best device today. The Viva XT bi v pacemaker. However, as another poster mentioned, it may not be the device. But you may as well have the best.

Can you explain why it is the best algorithm? The Dr. did say that if I want the medtronic one then he will use it but that I am getting about half the battery life. No, it might not be the device but there is a slim chance that it might be and at this point, I have nothing to lose except a much shorter battery. Unfortunately, I don't know my intrinsic conduction rate.

 

[Anonymous]

Just request Biotronik Ilesto HF-T and be done with it. Device will most likely last 7+ years with daily remote monitoring. Heart Failure settings can be matched up closely with current settings in your Boston Scientific device. Also, very small chance you'll have to worry about a device recall as Biotronik has been mostly immune to those issues over the last 10+ years when compared to (Medtronic, Boston Scientific, and St. Jude Medical) other manufacturers.

 

[Anonymous]

I'm happy to hear everything checks out!!! Biotronic has had recalls/ issues in the past. They don't report as often as they are not a public company. The three other players ( Bsc ,Mdt, Stj) are.With Biotronic, you have to hope you have a rep in the area and a working programmer. If you ever have to go to the hospital and you tell them you have a BIO they might look at you and say "a what?", they are not used in all of the USA. Stick w/ what you have it works and it will last you a long time. Infections are a real problem, if a device pocket gets infected you might have to have the entire system extracted and that has its own sets of concerns. Since you are young the less change outs that you have to have the better!! See if they will back you off the BP meds for a couple of weeks and see how you feel?? Just my thought!! Sometimes even a little dose of any medicine in an individual can make a huge difference, either good or bad!!! Good luck!!

 

[Anonymous]

Bio is on the rise baby!!

 

[Anonymous]

Also, very small chance you'll have to worry about a device recall as Biotronik has been mostly immune to those issues over the last 10+ years when compared to (Medtronic, Boston Scientific, and St. Jude Medical) other manufacturers.

HAHA, BIO is mostly immune to recalls? CRDM companies with no recalls scare the bejesus out of me. Plus, if BIO is all that great how come they have virtually no market share in the US? Give me a break.

 

[Anonymous]

this is what an explanted biotronik device looks like — "case report withdrawn from europace"
http://cardiobrief.org/2010/10/09/the-plot-thickens-in-the-case-of-the-exploding-icd/

do yourself a favor and stay away from bio.