Heart Rhythm Expert Forum
questions on pacemaker
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questions on pacemaker

Dear Doctor:

My mom is 62 years old.  She has low heart rate for a couple years.  Recently it is getting worse: she can't sleep well sometimes at night.  She did 24h heart rate monitoring a couple times.  The heart rate is below 40/minute sometimes at night.  Also, she had short time heart beat stop (1.7 sec).
My questions are:
1. Are all her syptoms (symptoms) the indication to get pacemaker?
2. What is the general steps to implant a pacemaker?  
3. What is the estimated cost for implanting a pacemake overallr?
4. My understanding is that there are various pacemakers on the markert.  Can you recommend one to me?

Very appreciate all your help!!

Jenny
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Those are good questions.  Make sure you ask her her doctor all these same questions.  I think this forum is a good place for information but cannon substitute for hearing the answers from her doctor.

1. Are all her syptoms (symptoms) the indication to get pacemaker?

The general rule is that pacemakers should be avoided for slow heart rhythms or pauses during sleep.  The key is does she have slow heart rates while awake and does she have symptoms.  I find this a very subjective decsion in borderline cases.  It can be difficult to determine who is fatigued from slow heart rates from people that just have fatigue.  That being said, appropriately selected patients can truly have significantly improved quality of life.

2. What is the general steps to implant a pacemaker?  

a. informed consent
b. concious sedation in lab and local with lidocaine
c. 3 cm incision under the left clavicle and creation of a small pocket for the pacer
d. IV access
e. placement of the lead (s)
f. secure the leads and device
g. close the pocket
most people will stay the night in the hospital depending on insurance rules.

3. What is the estimated cost for implanting a pacemake overall?

I do not know the actual cost.  I know that sounds bad but I have tried to determine what it is before.  The problem is that there are physicain fees, lab fees, hosptial fees, etc.  It is hard to get one final number.

4. My understanding is that there are various pacemakers on the markert.  Can you recommend one to me?

Medtronic, St. Jude and Boston Scientific all make good devices.  Some of the decision is based on local service in that area and I do think this makes a big difference. It also depends on conduction properties in the heart.  In a situation like that, I would probably pick a Medtronic device that reduces venricular pacing like an Adapta or an EnRhythm.

I hope this helps.  Thanks for posting.
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