Who has the best ICD out there?

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Who has the best ICD out there?

Post by hugooc » July 9th, 2008, 12:57 am

Is it Medtronic, St. Jude Medical, or is it Boston Scientific? Do you know? Do you care? And are you confident you have the very best device you can have buried in your chest or ... you just hope so?

Questions about quality, durability, and features come to us as a no-brainer when we’re considering a new cell phone, HDTV or digital camera. But why don’t we give it a second thought when it comes to ICDs?

When we get our first implant, we're usually not asked. Most of us don’t even know that there are choices. But some doctors only implant Guidants. Others only work with Medtronic. Are we comfortable leaving this decision up to our doctors?

I get it that most of us (me included) wouldn’t be able to pick the model of ICD most indicated for our condition, but we should at least be able to tell which device:
  • Uses the best battery technology (because the ICD will last longer),
    Has the shortest charging time (because the ICD will defibrillate you before you pass out and hit your head on the bathroom sink)
    Will not pace you unnecessarily (because excessive ventricular pacing will increase your risk of heart failure.)
Do you know?

Even features that at first glance may seem like an unnecessary luxury, such as wireless telemetry, might make a huge difference for the 1% to 2% of patients who will develop an infection after the implantation. (Wireless telemetry eliminates the need for the programming wand in the sterile field.) So, did you request a wireless device?

Or are all devices pretty much the same and I just need to calm down?

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Post by *karenb* » July 9th, 2008, 5:37 am

You know, its much easier in the UK...we don't have a choice. I had the 'latest' (at the time) Guidant Vitality following a catastrophic battery failure in my previous ICD. I have to trust my clinic's decision and as they have more experience than I have, implant over 50 every year, see the latest research, and have the follow ups with hundreds of patients I'm happy with that. I understand that some like to have all the detail and compare technology and features, but you know, for me, I just have other things I'd rather be doing, and that's no reflection on those who do want to know! I'm the same with my car, my phone and other technology. I take it for its services, but as long as it works, and gives value for money I'm happy. I also know that the more I think my ICD and my heart condition the worse my anxiety gets, but I may not be typical.
First ICD 2004.
Current ICD implanted 09/06

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ICD Varieties

Post by Sparkydog » July 9th, 2008, 5:47 am

Maybe we could get Consumer Reports to do a study, 'cause I don't think there's an official/government agency that really tracks these things to be able to give any meaningful information, and even if it could tell us certain things, the possible trouble areas (ie the unit wiring, leads, battery) would be difficult to really come up with a "winner". Would you want to take your chances with a manufacturer of bad leads, defective batteries, or one that has the occasional internal wiring problem?

I have had a St. Jude for a little over 3 years with nary a peep from it, but have just about decided not to replace the unit when it goes.


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Post by xislandman2004 » July 9th, 2008, 6:20 am

Not replace unit...

Interesting. Why would you make such a decision?

Hypertrophic Cardiomyopathy - Heart failure
First ICD Medtronic 5/16/08
Pulmonary Vein Ablation 9/1/10
Second ICD Medtronic 5/8/12
AV Node ablation 12/23/13
Medtronic Viva CRT-D 4/14/14
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ICD Replacement

Post by Sparkydog » July 9th, 2008, 6:36 am

I have an enlarged left ventricle, with an EF of 30 - 35. No other symptoms, no irregular heartbeat, nothing. Doctor has no idea why or when the heart became enlarged or why the EF is as it is. I don't like living with the thought that I have a ticking time bomb in my chest and that once it ever went off, I'd be a basket case. What sort of life is that? Yes, I know my attitude towards the ICD is of my making, but that's just the way it is for me.


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Post by sunny4az » July 9th, 2008, 9:29 am

Wow, I have never heard an ICD called a ticking time bomb. In my case the ticking time bomb was my heart. I had a heart attack with no known risk factors. I subsequently got an ICD and had to question why they put this thing in my chest but decided it could not hurt and would just get used to it and not worry. As it turns out, it has saved my life three times now. I think you are overly concerned about getting shocked. It is not that bad (the voice of 11 ICD shocks here) . The first time I got shocked, I did not even know what happened. I was placing a ladder on the ground near an extension cord when I got zapped. I thought the extension cord was bad and had shocked me. I checked the cord and it looked good so as I stood there wondering how I got shocked I finally realized it must have been my ICD. I called my EP and they had me come in and interrogated the ICD and found I had gone into VT. I have worked as an electrician and electronics repairman for the most of my life and have got shocked many times. The ICD shock was about the same as getting shocked with 120 volts, and much less than some of the shocks I have gotten from high-powered electronic equipment.

Bottom line, try not to worry. In my opinion the reports of getting kicked in the chest etc. are greatly overstated.
Joel in sunny Arizona

Medtronics Maximo 7232CX. Mexiletine 150MG 2X, Coreg CR 40MG 1x, Lisinopril 2.5MG 1X, Plavix 75MG 1X

3-life saving therapies and 1 electrical storm w/8 zaps

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Post by ~guin » July 9th, 2008, 10:25 am

Very interesting topic Hugo....

In my case - back in 1999.... The choice was made for me given not only my health history but my travel... I didn't know this until after the fact... Stanford had all manufacturers on the shelf and with the EP study and my travels they chose the Medtronic GEM II. Medtronic is the most well known manufacturer worldwide. So if I am in a forgein country at least I have some hope of someone there knowing how to treat me...

My first ICD was recalled 5 mos after implant with "occasional internal wiring problem". There were 50 units affacted world wide - three of them at Stanford and one of them mine!!! What are the odds of that?? Anyway Moedtronic was wonderful in the recall and treated me sooo well that I swore I would only have Medtronic from there on.
Or are all devices pretty much the same and I just need to calm down?
To answer your question Hugo, I think each manufacturer are pretty much the same as far as the makes and models they produce. I feel the right decision was made for me with my two lead and I have the option of going to a three lead when my heart needs it. All the mnfgrs have had recalls on their units/leads, so you you really can't say one is more reliable then the other. I am sure glad I've got my big heavy leads though. I might not feel that when they have to be removed, but they have served me well for the last 9 years!

I have had to move on and feel the best decision was made for me.
Lots of food for thought here! Thanks for sparking it Hugo.
Last edited by ~guin on July 9th, 2008, 11:20 am, edited 1 time in total.

Keith of WI

Post by Keith of WI » July 9th, 2008, 11:14 am

To me I've had a St. Jude, now a Medtronic! Choice of manufacture seems to be with the Dr. EP, what he feels is the best to meet your heart conditions, present and future! Some places go with mainly one manufacture I have changed clinics about 30 miles apart in sort of rural WI, first one was St. Jude, next one was Medtronic, depends on I guess what the Dr.'s want the Hospital to keep on hand.

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Post by notvaporlocked » July 9th, 2008, 1:51 pm

I have the Medtronic EnTrust. My Dr felt it was the best match for my conditions. He gave me a few features he liked about that particular model and why it was a good fit for me before the surgery. I have to trust him for my general heart treatment so its not difficult for me to rely on his experience with the different makes and models to feel comfortable with it.

My brother is a research everything kind of guy. I see how in many ways it cripples hiim. Analysis paralysis.

We have to trust our Dr's don't we?

Am I to trusting when it comes to healthcare?

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Caution long respons...

Post by Kat » July 9th, 2008, 2:06 pm

Great question Hugo... I really had to do some thinking on this.

My opinion is that looking for the differences between the ICDs themselves is like splitting hairs... like choosing between a Lexus and a Mercedes. They all have about the same features to address the same issues and treat them the same way. They are all going to point out the small differences and hype them up as selling points, but really, they are basically the same.

For me, it comes down to service. The service a company provides a customer is the only real difference between the products. They are all good at it when things go well, but when things go wrong can be the most telling time. Guidant found a problem with their product and then tried to cover it up and hide behind lawyers instead of letting people know… as a result, people died. As a result this is not someone I want to do business with. It is hard enough to trust that major corporations have my best interest at heart and not their profits as it is. I know that they have been bought out or have been reinvented as Boston Scientific, but a company that has a history of this behavior is not going to get my business. If fact, the only thing I told my doctor after I decided to have the implant was no Boston Scientific.
Disclaimer: I know people with these devices and they have had no issues and I am not saying the whole company is crap, I am just saying that giving the choice, I don’t want to do business with them. And that is what we are doing when we agree to have their products implanted in our bodies, we are doing business with them.

None of the companies have a perfect tract record and as I have said before, nothing made by man is perfect. However, if something goes wrong what that company does is important. With the latest recall from Medtronic (Fidelis Leads) the company warned doctors that they were seeing a problem but didn’t know if it was the lead or the way they were being installed but still it raised the flag. After gathering further information, they decided to pull the product. I still hate that I have one of these leads and I hate that worried feeling that it may break at any time on any heartbeat but I have managed to stuff that worry down into a little manageable box that I put in the far corner… for now. I still believe they made the best decision. Any remaining issue I have with them is on how they got this product approved without any human trials (called bench marking) but that means my issue is with the FDA that allows this practice.

So, to me, it is the service a company provide that is the real difference and not the minor bells and whistles they glorify in marketing brochures.
~Kat - Hypertrophic Cardiomyopathy
-That which does not kill us can really mess up our hair!
-Having one near life experience after another.

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Post by Kathy B » July 9th, 2008, 4:21 pm

The best is the one you have at the moment. Comparing ICD's is like Kat said a Lexus versus a Mercedes....go figure, I just ordered a BMW.
Kathy B
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Post by CarmenW » July 9th, 2008, 5:24 pm

I doubt with my HMO that I will ever even get a choice in what ICD I get or where it's implanted (under skin or subpectoral). Maybe I'm wrong about that. I don't even get much choice over what doctors I see. I didn't pick my EP, my GP sent me to him. I worry about a lot of different things about my ICD, but because I have no control of over it, the brand of ICD is insignificant in my opinion. I have made the choice to trust my EP, at least because I have no reason not to and he's a really likable guy and is highly praised. I don't know enough about the business practices of either ICD company to judge. I don't really trust any for profit companies and just hope they use a significant portion of their profits to do more research to make these puppies smaller and better and all that. I think what matters is having a doctor who knows how to pick the right equipment for me. I know I'm not qualified to do it. What I still want to know, HUGO, is how often to Medtronics and BS reps take these docs out to lunch and how much does that influence the equipment we're walking around with? I guess they're not going to answer that on one of your conference calls.

What I do worry about...can these ICDs cause damage to our bodies? I mean, I know they can malfunciton and misfire and all that...but what kind of metals and plastics and so forth are these things made out of? Can chemicals from these devices leach into our bodies...can the electromagnetic rays or whatever signals are sparking around in there cause long term damage? How many shocks does it take to damage the heart muscle, or is that not possible? I'm 34, what are these leads going to do to my vein over the long haul (and I'm hoping it's a long haul).


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Post by cindy mcpherson » July 9th, 2008, 8:05 pm

Hey Hugo, I love the term "analysis paralysis", GOOD QUESTION. I just told my EP, as I was lying in ICU, just make sure you don't put anything in there that is going to be recalled. Hah!!! Now we have the lead problem.

Your anylitical nature is showing. We will never know the exact chart of differences, you'll just have to be cognizant of your own device and its limitations. I hope they will come up with a wireless ICD. You know, only small chips implanted in heart muscle and the unit transmits to the chips, no wire, etc. Maybe they are in the works????

I think we all over-think our situations, I like Karen B's attitude, but it wouldn't work for me. I'm like you, I must know all that is available. By the way Doreen Henderson at Medtronics says HI! (see what I mean?)

Happy fact finding, ya"ll

Cindy (from Texas w/horses)

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Post by AndreaA » July 9th, 2008, 8:16 pm

Cindy, you were worrying about a device that would be recalled and all I said to the EP was "just don't interfere with any future breast augmentations!" - We each have our priorities!! LOL!
Long QT Syndrome -
Sudden Cardiac Arrest 5/13/08;
Medtronic Virtuoso DR 05/16/08
West Palm Beach, Florida


Post by karslake » July 10th, 2008, 1:44 am

Hi Hugo,
Well, I go with Medtronic, have done now for 10 years. My first was Medtronic Gem, the second a Marquis which, in some cases had a battery fault. I had only had mine in a year when certain models were recalled. I saw this on the internet so immediately phoned my Cardio/EP. She said "You must have been on the Internet- I've only just been informed myself.
Come to Perth (400 miles south) next week and I'll replace it." Which is what she did. No charge at all, for ICD or hospital - all paid for by Medtronic! I now have a Medtronic Maximo - only 2 leads, as apparently a third lead would not help me any.
Eve & Blabbermouth 111

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