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Patients test drive pacemaker before choosing permanent implant

Patients can now test drive a pacemaker outside the skin before deciding whether to have a permanent implant, according to novel research presented at the EHRA Europace Cardiostim 2015 meeting, held recently in Milan, Italy.

The study was conducted in patients with bradycardia over a period of nearly four years. Six patients aged 40 to 82 years were offered a two to three week test drive to allow them to assess the potential benefits of permanent pacemaker implantation.

Procedures were conducted in an electrophysiology lab. A needle was stuck directly into the subclavian or axillary vein and a permanent pacing lead (or leads) was passed percutaneously and attached in the atrium or ventricle (or both). The leads were fixed to the skin and attached to a non-sterile permanent pacemaker which was sewn to the skin and covered with a waterproof dressing. The pacemaker was programmed to a rate-response mode at an appropriate heart rate for each patient and removed after two to three weeks.

All six patients subsequently chose to have a permanent pacemaker implanted under the skin. There were no complications associated with the initial implantation procedure, the trial period, or device removal.

Co-author Professor Michael Giudici, (University of Iowa Hospitals and Clinics, Iowa City, USA), said: “By doing this procedure we allow the patient to see the before and after, so they can make a much more informed decision…Patients have numerous concerns, such as body image issues. There will be an incision in the upper chest, perhaps some discolouration of the skin and a lump which may be visible depending on what you wear. In women there are intimacy issues with upper chest device implants and we usually consider a submammary location.”

Professor Giudici came up with the idea for a test drive after using the technique successfully in patients who were already dependent on a pacemaker but needed to have it removed temporarily because of a device infection. These patients had all their hardware removed and were required to take antibiotics to clear the infection before receiving a new permanent device.

Professor Giudici said: “We would give them what we call a temporary permanent pacemaker. You use a permanent pacemaker and a permanent pacing lead but the device is just on the outside of the body. In symptomatic patients with slow heart rates it’s hard to know for sure that the reason these people feel poorly is because their heart is slow. This was a nice way to test the hypothesis that your slow heart is causing your problem without committing them to a surgery and a permanent pacemaker.”

“The test drive enables patients to go into their procedure much more confident that the pacemaker is going to do them some good. It also allows the patient to make the choice, which ultimately makes them much happier than if the doctor just tells them they need it,” Professor Giudici concluded.

The full scientific programme for EHRA Europace Cardiostim 2015 is available here: http://www.flipsnack.com/Escardio/ehra-europace-cardiostim-2015-advance-programme.html

References

1. Professor Michael Giudici presented the abstract ‘Undecided about getting a pacemaker? Take one for a test drive’ during Poster session 3: Indications & Results (Pacing) on 22 June. Full details are available here: http://spo.escardio.org/SessionDetails.aspx?eevtid=1087&sessId=16282&subSessId=4331&searchQuery=%2fdefault.aspx%3feevtid%3d1087%26days%3d%26topics%3d%26types%3d%26rooms%3d%26freetext%3dgiudici%26sort%3d1%26page%3d1%26showResults%3dTrue%26nbPerPage%3d20%26
WithWebcast%3d%26WithSlides%3d%26WithAbstract%3d%26WithReport%3d%26scroll%3D0#.VWQmJ89Viko

Published on: June 26, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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