> allowing for doctors to check in on their patients and replace either the batteries or the pacemakers themselves
I cynically read this as "we needed to get more money out of these patients"
I cynically read this as "we needed to get more money out of these patients"
Additionally, any kind of implanted device is significantly prone to a wide range of problems that range from inconvenient to devastating. The human body is very hostile to foreign objects, often with few warning signs. Clots and fibrous capsules (and eventually, calcified capsules) form around ANY implant, and that's the best case problem.
Titanium is extremely biocompatible. It forms a thinner capsule than most materials. It integrates with bones beautifully, due to surface treatments that allow bone to grow into microscopic surface cavities, with strong molecular bonds. But also sometimes, for no apparent reason, all the bone around a titanium implant will just start dying and resorbing. It's rare, but if you get a hip replacement you absolutely need to check on it regularly because if you don't you'll lose use of the leg completely (and quickly, and permanently).
In and around the heart is one of the most challenging places to implant things, aside from maybe the brain. Any moving part of the body will constantly stress any mechanical part, and build up scar tissue around and rubbing spots. The only reason the brain is worse is because its fragile and changes size significantly when you sleep.
Recently we started using leadless pacemakers. Even before that pacemakers were continually getting smaller, and smaller pacemakers are less irritating and experience less stress and movement. Even if that weren't true, it would still be worth checking in on pacemakers, because they're doing incredibly hard jobs and if they fail people can die faster than they can get to a hospital.
EDIT: oh, and heart disease is the #1 cause of death in the US, while heart surgery is one of the most difficult specialties to get in to. They are absolutely never short on patients, lol.
Maybe my cardiologist is just trying to make me feel good, but he says my leads will likely last 30-50 years. Intuitively that seems unlikely, but we'll see. It's got to be one of the most engineered cables in existence.
The leadless pacemakers are indeed a technical marvel, but they aren't yet nearly as feature packed as shoulder implanted devices. They'll keep your heart from stopping if your nerves are flaky from time to time, but they don't have the energy storage to do much more than that. Mine monitors every single beat my heart takes, and automatically reports issues to my doctor via BLE. (Is bluetooth more or less scary than radioactive isotopes mounted in your body?)
For about 8 months, my AV nerves were completely broken, and the pacemaker paced my ventricles 100% of the time. It was a nearly perfect drop-in replacement for the failed nerves. A leadless pacemaker wouldn't have had nearly the same performance. My nerves eventually started mostly working again, and now I'm on track to have a battery life pushing 15 years.
It would of course be great for the technology to advance even more over the next decade. Since my nerves mostly healed, a leadless device with a 30+ year battery life would be a nice replacement. With a shorter battery life, I don't really want to be collecting them in my heart (they don't plan to remove leadless pacemakers when they die.) I'm hoping by the time my current device is worn out, it will have logged enough telemetry for me to convince my cardiologist that I don't need a pacemaker at all, though.
One of my favorite learnings in school was about the "Endurance limit".
Some materials, like aluminum, will eventually fail under cyclic loading even at tiny, tiny loads. This was a big problem when they built the first passenger jets. Other materials, like steel, have a threshold at which they can be cycled indefinitely without issue.
For something like a pacemaker, I like to imagine they dialed the materials and forces to be within such a threshold so you can keep on ticking!
What I want is a shoulder implanted pacemaker that's significantly smaller, with a quarter of the primary battery capacity, and an inductively charged supercap that can store enough charge to run at least week between charges.
BLE replaces the previous diagnostic interface, which was some form of near-field. You had to have a puck resting within a few inches, going to a several decade old toughbook. My device supports both. It's just in the last couple years that UCLA got the BLE equipment, and sometimes a doctor will whip out the old gear if they feel more confident with it.
When I had the pacemaker first implanted, there was a reliability problem they had to do a second operation to fix it. The pacemaker failed to "capture" my ventricle a few times when it should have. It turned out to be a loose lead connection, but the device's impedance diagnostics didn't make the issue immediately obvious. My overall case was weird enough that UCLA did a case study about it, so for the revision procedure they had a vendor rep in the room to help out just in case. She was holding a tablet and pushing buttons that would make my heart temporarily stop.
Now my AV nerves mostly work again, so the pacemaker can't stop my heart if it wanted to. It can only increase my heart rate, and report unusual patterns to my doctor. Also, if someone did somehow mess with it, holding a strong magnet near it will force it into safe mode.
You would think if you can detect a strong magnet, you could use that to turn the wireless on and off... Like how holding a power button on a phone turns it off, but holding longer can do a factory reset or what have you.
Glad you're doing better since then, though.
eliminating RF/BLE bullshit from talking to the pacemaker.
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Oops - I didnt realize you were same poster from other comment
If you got in you could probably put the leads into single-ended mode (so that there's more current path to cause mayhem) and pace my atrium and ventricles at 210bpm, and effectively give me a seizure. I can't imagine it would kill me before an EMS arrived with a magnet?
Perhaps a more nuanced attack would be to somehow use all the configuration parameters to intentionally bias the pulses so that there's net charge going into the muscle. Over a long time that would cause tissue damage.
If someone wanted to kill me overtly, a gun would be less work. A pacemaker malfunction that bad would be thoroughly investigated, and would be fixed in new devices within a year or two.
Perhaps, he got the 'reverse bounty' on this bug...
Nah, it's not that bad. Decent mechanical keyboard switch is specified for 100 million clicks [1, or google for "switch million actuations"]. Surely good engineering can eek out another order of magnitude. Not to mention - pacemaker leads ("wires"), the only part that bends, have way less stress on them (= larger bend radius) compared to a keyboard switch. Oh, and technology of multi-strand wire for redundancy is a very well established and understood one.
[1] https://cdn-shop.adafruit.com/product-files/4974/EN_CHERRY_M...
I'm going to assume those failure numbers are far higher than you'd want for something keeping you alive.
The doctors keep quoting figures of how reliable this tech is, but I've had 3 procedures due to device failure in the last 5 years.
This is still relevant to his concern, but from the other end. They might be making the labor artificially scarce to increase pay.
This is very much true. I find that a lot of people in tech seem to put healthcare on a pedestal and believe that the professionalisation and gatekeeping of the industry create a better outcome than other engineering fields. This is very much untrue, the healthcare field is in need of massive disruption and lobbying to increase labor supply. You are being downvoted because a lot of tech people here hate to imagine that healthcare at the highest level is still subject to market forces like everything else. Medical training is being severely gatekept and hindered via the current apprenticeship/residency system. After all, we call the worst medical student, doctor. If you want to improve healthcare, tie medical school admission to the MCAT score, and only the MCAT score. You are not going to get better doctors just because candidates spend their summers building houses in some impoverished third world country.
I heard consistently that residency slots are extremely competitive and a lot of qualified candidates get passed over. The more I learn about the process the more insane it seems.
From the student perspective you go from paying to work one day and spending most your time working cases with zero relevance to your actual specialty, to raking in several hundred thousand a year.
It also seems like hospital systems seem to spend more than half their capacity either dealing with patients that don’t need to be there but there’s literally no place to send them, or patients that are too far gone and untreatable but there’s literally no place to send them.
Healthcare is like a Gordian knot of terrible policies cemented into place by trillions of dollars of government spending.
Heart surgeries often happen on actively beating hearts. Tiny mistakes mean death. Infections mean death. Its a muscle which never gets rest, the majority of people in the US have clogged arteries and high blood pressure by the time they die.
Theres no artificial shortage. Heart surgery is really hard. Its the third hardest kind of surgery, right behind brains and rockets.
Wait,what??
I agree that a surgeon at a general hospital probably wouldn’t care (little financial incentive).
The vast majority of pacemakers are placed by cardiologists with an additional two years of training in electrophysiology (not by cardiothoracic surgeons, who prefer to do complicated open heart surgeries and generally find things like pacemakers boring).
Contrary to the conspiratorial thinking all over this thread, medical society guidelines have scaled back the indications for putting in pacemakers time and time again, so the market has shrunk. Electrophysiologists have to make up for the lost pacemaker volume by doing newer procedures (ablations) that reimburse less per hour of work. Even then, the volume at a lot of shops isn't enough to merit full time work. A lot of graduating electrophysiologists have to take mixed electrophysiology/general cardiology jobs where less than 50% of the work is electrophysiology.
All that is to say, no, pacemakers are not a money making scheme. While there is decent money to be made, it's a shrinking market and those who got obscenely rich putting in pacemakers in the 80s and 90s have mostly already retired.
[0] When the pacemaker detected a problematic arrhythmia it would give a couple of defibrillation shocks just like the paddles but right on the heart muscle. He said this felt like getting kicked in the chest by a horse and came completely out of the blue with zero warning. So it could be quite disruptive. He wanted a feature where it would tingle or beep or something just a few seconds ahead of time so he could mentally prepare; apparently the second one that was expected was a lot less traumatic. Anyway, the docs thought it was a good idea, and passed it up, but it never happened before he passed.
reminds me of the pre-safe sound prior to collision
https://www.mercedesbenzofnatick.com/new-features-mercedes-b...
Heart problems are funky.
Most patients don’t survive those 10 years anyways.
My understanding is that people diagnosed with bradycardia young can expect to survive a long time with the device.
He died in 2014, not from heart-related issues.
I'd say that was a good return on medical investment.
We're all going to die and an extra 9 years is not bad.
I see people Dad's age or older driving and walking around and I find it amazing how older people are alive. Elderly people are amazing as people and for their knowledge.
Love every day you and your family are here and healthy!
> I personally could be realistically looking at 3 replacement devices and at least one lead replacement over the years. In the unlikely event that I suffer from ventricle enlargement long term, I'd need two more leads installed as well.
This is the point I'm making, though: realistically, you have a high chance of needing 2 additional procedures for non-battery reasons, which are likely good times to replace the device, too.
Unfortunately in the OECD I think its possie for an American to read it this way due to the unusual health system. Don't get me wrong... things are changing elsewhere too... it used to be a great shame to go sue a surgeon for anything but reckless intentional negligence... after all we all have bodies that age and decay and the surgeon is provided freely as a public service and their profession is to try as best and compassionately as they can with their training they recieved freely to delay or prevent the suffering inevitable from life... now people sue here for like an orthopetic surgury that simply didn't produce any result ... we are becoming more like america it is sad.
Same. In what world can a lifesaving device run excessively long? One with our health system is where...