Pacemaker vs AICD, why the delay?

[qaqueen]

Can anyone explain why a patient can have a pacemaker implanted post op, but must wait three months to have an AICD placed?

I am confused about the need to wait on an AICD. This requirement causes a duplication of the procedure and additional costs to the patient/insurance company.

Why not place a pacer with AICD and not turn on the AICD function for three months?

I suspect that there may be a good reason for this, but have not found the answer anywhere to date.

Thanks for your input.

[dianah, ASN]

If, with "optimal medical management," the EF rises out of the range for indication for implantation, there is no longer a need for the device.

Practice has been: Initial diagnosis, initiate medical therapy and after three months of therapy check the EF (and pt) again. If EF remains low, implant device.

According to the following article, practice may be changing:

Indications for ICD Therapy for the Primary Prevention of Sudden Death in Patients With Left Ventricular Dysfunction and a Narrow QRS Complex

I googled "indications for ICD" and this was one article that popped up.

Interested to see other responses. :)

[qaqueen]

Thank you for the info!

[delphine22]

I know there's a medicare waiting period. . .that's why sometimes pts are sent home on a lifevest for 90 days. This is for AICD only, not PPM. Ideally they shouldn't have to do two procedures, but I guess the pt couldn't wait for the pacemaker.

[ghillbert, MSN, NP]

It depends what patients you are talking about? What is the indication for PPM/ICD? We frequently place PPM/ICDs less than 3 months after cardiac surgery, so you'd have to be more specific about the procedure and the diagnosis code.

[maverick87]

Pretty much what dianah said. After cardiac surgery with better circulation (bypassed vessels), proper medical management has been shown to SOMETIMES improve the EF. Some will f/u with the cardiologist and have a repeat echo ordered after a certain amt of time, and sometimes the EF will improve thus not needing an AICD. This is usually with patients whose EF is borderline for needing an AICD. A lot of patients requiring CABG that have a low EF usually have ischemic cardiomyopathy, which means that the heart is used to pumping with somewhat limited circulation. Plus as with everything else, insurance also plays a part in it.