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Combined ICD/Pacing Devices

Combined ICD/Pacing Devices. What’s new in the pacing world?. What options are available?. William A. Shapiro, M.D. http://anesthesia.ucsf.edu/shapiro. What’s Not New - Your Best Friend. Charles L. Witherell , RN, ACNS-BC, MSN Clinical Nurse Specialist, Pacemakers

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Combined ICD/Pacing Devices

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  1. Combined ICD/Pacing Devices What’s new in the pacing world? What options are available? William A. Shapiro, M.D. http://anesthesia.ucsf.edu/shapiro

  2. What’s Not New - Your Best Friend • Charles L. Witherell, RN, ACNS-BC, MSN • Clinical Nurse Specialist, Pacemakers • Cardiac Electrophysiology Service • UCSF Arrhythmia and Device Clinic • 350 Parnassus Ave., Room 204 • Pager:  415 443-3786 • Voicemail:  415 353-4032

  3. What’s Not New The algorithms that each company uses to create their ICDs and Pacemakers are among the company’s most closely guarded secrets.

  4. The Pacemaker Companies • Medtronic: http://www.medtronic.com • St. Jude Medical: http://www.sjm.com • Boston Scientific- http://www.bostonscientic.com Boston Scientific now owns Guidant • All 3 have humans answering the phone 24/7/365 • FDA- http://www.fda.gov/cdrh • AHA- http://www.americanheart.org

  5. The Pacemaker Card • Physician’s name • Generator and lead serial numbers • Manufacturer tech support number The pacemaker card does not contain any information about the current programmed mode, the magnet response, the reason it was inserted, or when the pacemaker was last checked

  6. Guidant T-180(ICD/Pacemaker) • First released in 2005. This model is still available. • ICD- Defibrillation for V-fib, or rapid V-tach • Anti-bradycardia pacing- ventricular pacing only. It only has an inhibited (synchronous) mode. Fixed-rate (asynchronous) pacing is not a programmable option. • The ventricular rate is programmable, but of course, it will always remain in the VVI mode after programming. It cannot be put into a permanent fixed-rate pacing mode. • Not to be confused with the T-1000, which is the “fictional” android assassin featured as the main antagonist in Terminator 2: Judgment Day (released in 1991).

  7. Guidant T180 (ICD/Pacemaker)(Guidant is now Boston Scientific) • Why might a pacemaker not have an asynchronous mode option? • What is the danger of an asynchronous mode option? (Hint- Same as question above) • Answer: The companies are afraid of a fixed rate pacemaker spike causing an R-on-T induced ventricular tachycardia or ventricular fibrillation.

  8. Pacemaker Induced “R on T” Arrhythmia

  9. What’s New ? All 3 American Pacemaker/ICD companies now provide ICD/Anti-bradycardia pacemakers in which the ICD function can be inhibited, and the anti-bradycardia pacing can be programmed into either the inhibited or asynchronous (fixed-rate) mode.

  10. What’s New ? • Technology marches forward- generators will have more options. The devices will get smaller and lighter. • New combined ICD/Pacemakers now have an “on/off Electrocautery” mode. • Once the ICD is off, the pacer can be either fixed rate or inhibited. Pacing can be VOO, AOO, or DOO, at any rate.

  11. What’s New ? • Minimal Ventricular Pacing (MVP): A proprietary Medtronic feature where the pacemaker learns to reset its own mode from sensing the patient’s cardiac conduction properties. AAI->DDD • In-home wireless monitoring of pacemaker activity. The information is sent to a remote “secure” company database.

  12. What’s Not New - Your Best Friend • Charles L. Witherell, RN, ACNS-BC, MSN • Clinical Nurse Specialist, Pacemakers • Cardiac Electrophysiology Service • UCSF Arrhythmia and Device Clinic • 350 Parnassus Ave., Room 204 • Pager:  415 443-3786 • Voicemail:  415 353-4032

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