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  • Self cardioversion

    Hi everyone,

    It's been years since I have posted on the HCMA boards so hi to old friends and hello to new ones! I was wondering if anyone out there has used a handheld device to self-cardiovert out of afib? The device works by communicating with your ICD. Ever since my myectomy (2005) I have had repeated episodes of afrib which will only end with electrical cardioversion (I've done one PVA already with no luck). Following several in-hospital cardioversions I managed to get a handheld device made by Medtronic called the 'Incheck Patient Assist', which you can use to cardiovert yourself without the hassles of going to the hospital.

    I have used the device 4 times so far successfully. The only problem is that it is a very unpleasant experience. I can only compare it to a bomb going off in chest. I've tried to take valium and this really doesn't really help. Has anyone else used the Incheck device? If so, has your doctor prescribed something stronger my to help you deal with the pain and anxiety of doing a self-cardioversion?

    Many thanks, Paul
    Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

  • #2
    Re: Self cardioversion

    Hi Paul. I'm sorry but I've never heard of this device. Maybe someone else will be able to shed some light on their experiences. Besides the afib how are you doing?
    Reenie

    ****************
    Husband has HCM.
    3 kids - ages 23, 21, & 19. All presently clear of HCM.

    Comment


    • #3
      Re: Self cardioversion

      I too have never heard of this but I Googled it and found this FDA site that approved it in 2001. It seems to be a total system, ICD and the external device which should be used with extreme caution and it will only work if the ICD should have and did not deliver a shock. I may be misinterpreting what I have read but am sure someone (Gordon) will correct me.

      The jury (me) is out on whether or not this is a good thing but I do believe in the hands of the wrong person it is more dangerous than the symptoms it is designed to correct.

      http://www.fda.gov/MedicalDevices/Pr.../ucm089056.htm

      Sorry, Gordon, but you have the training to read and understand these technical writings better than I do.

      Comment


      • #4
        Re: Self cardioversion

        I may have more training, but I don't know that much about ICDs. I confess that, since I don't have one, I haven't devoted a lot of energy to learning about them.

        From my standpoint, I think I'd be reluctant to have one of these -- but admittedly I'm not trying to cope with repeated episodes of afib. During my only afib episode (while hospitalized, after my myectomy) there was some discussion about whether to use drugs or electrical shock. The conclusion was that shock wasn't the way to go: I kept drifting in and out of afib, and they thought that if they shocked me, there was no reason to expect me not to drift back into afib. I wonder whether a device like this might not have the same problem - perhaps it can restore sinus rhythm, but the underlyiing problems causing afib are still there, so one has repeated episodes. This is just a concern; I really don't know the answers.

        Gordon
        Myectomy on Feb. 5, 2007.

        Comment


        • #5
          Re: Self cardioversion

          It seems to me that we had one member a few years back who used her device to cardiovert her a few times. I think she took a valium before she did it.

          The one thing that really concerns me about this do it yourself method is that unless you have a scan before the cardioversion, you may have a clot that you are not aware of. Unless properly anticoagulated, you could dislodge a clot and give yourself an embolism or stroke which you certainly don't want.
          Daughter of Father with HCM
          Diagnosed with HCM 1999.
          Full term pregnancy - Son born 11/01
          ICD implanted 2/03; generator replaced 2/2005 and 2/2012
          Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

          Comment


          • #6
            Re: Self cardioversion

            Even though I do not have an ICD I do care about those that do have it and some of those concerns are:

            1. If you do need to use the "Assist" is it because your ICD is faulty; is it because the ICD needs reprogramming or is it because you are really not having a-fib and therefore should not have used it?

            2. If you do use it do you alert you doctor immediately or go to an ER which I understand is what you are supposed to do if you get a "shock" from the ICD?

            3. Are you using it too often, meaning every or almost every time you feel something which may or may not be a-fib.

            I hate to play Devil's Advocate but this really bothers me.

            Comment


            • #7
              Re: Self cardioversion

              Frosty- All very valid points.
              ICDs do not help with Afib. The only thing similar is the shock thats given. I assume this device delivers something similar. Personally, having had my device fire, I could not imagine wanting to do that to myself (hence Valium). And playing Devil's Advocate, I was once in Afib for 7 seven hours and can see wanting a solution ASAP.
              This is a unique situation and if we've all learned one thing, HCM is unique for each of us!
              Marc
              Diagnosed @ 48
              Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
              Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
              AICD - Valentines Day '08, Spark Plug replaced 11/14
              After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
              Quietly going insane . . .

              Comment


              • #8
                Re: Self cardioversion

                Hi Reenie, other than the afib I am really good thanks. How are you?

                Paul

                Originally posted by Reenie View Post
                Hi Paul. I'm sorry but I've never heard of this device. Maybe someone else will be able to shed some light on their experiences. Besides the afib how are you doing?
                Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

                Comment


                • #9
                  Re: Self cardioversion

                  Thanks for all your posts everyone. Since my posting I used the device to cardiovert myself successfully. Yes, really horrible experience again - it took me 10mg of Valium PLUS a couple of shots of bourbon!!! (and I never drink liquor) before I could bring myself to do it.

                  A few things about my issues with afib: first, I know instantly when I go into afib - it is like a horse galloping in my chest and I feel really sick so this is how I know. Second, once I am in afib I can only go back into sinus after electrical cardioversion - usually in a hospital under anesthetic - I don't go in and out of afib like some people. Third, my ICD will not let me cardiovert myself if more than 48 hours has passed - this is to protect you against a clot getting flicked off into the brain. Finally, I am on warfarin and almost always in therapeutic range. So, getting clots and hence the risk of stroke is reduced.

                  As for Frosty's comments: no my ICD is not faulty - there is a function programmed into it which allows it to be used with a 'patient assist' device. It delivers a shock just like you would get in a hospital if you had an electrical cardioversion (the hospital here actually uses my own ICD to cardiovert me using a computer that sends a signal to my ICD!). There are risks, but these are minimized by the 48 hour limit to using the device (to protect against stroke). I look at it this way: I feel so sick in Afib that I need to be cardioverted ASAP. Unfortunately, without the patient assist device I would have to go to the hospital, where I spend all day and risk the doctor telling me they won't cardiovert me (this happened recently).

                  It's not nice and certainly not for everyone.

                  Thanks, Paul
                  Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

                  Comment


                  • #10
                    Re: Self cardioversion

                    Paul -

                    The only reason I mention "faulty" and "reprogramming" (in no way meant to convey I thought this was your ICD) is because from what I have read about this "system" is that it only works when the ICD should have but did not pick up an arrythmia and the Assist gives it the nudge that it needs to work properly.

                    Yes, I may be misinterpreting but I honestly don't think I am -- "The InCheck Patient Assistant is a handheld, battery-powered device used by the patient to administer the electrical shock if he or she is experiencing symptoms and the system has not delivered a shock. When the patient presses the button on this device, the system determines whether an abnormal rhythm is occurring and whether an electrical shock is needed. If it is, the shock is delivered."

                    I am just trying to gain some knowledge as there may come a time when my doctor insists that I get an ICD and I want to learn as much as possible prior thereto. My apologies if you thought I was in any way saying you are wrong for using this.

                    Comment


                    • #11
                      Re: Self cardioversion

                      Paul: I'm doing well, thanks. I'm glad to hear that besides the afib you're good tool.

                      Frosty: ICD's are not typically set to deliver therapy for afib. They can pick up the arrhythmia, but they aren't used to correct it like they are a ventricular arrhythmia. There have been several instances reported on this board though, where the person's device "misunderstood" afib and delivered therapy like it was trying to correct a ventricular arrhythmia. Once the device is reprogrammed it doesn't do that any more.
                      Reenie

                      ****************
                      Husband has HCM.
                      3 kids - ages 23, 21, & 19. All presently clear of HCM.

                      Comment


                      • #12
                        Re: Self cardioversion

                        Reenie -

                        I really don't want to prolong this but reading from the FDA it does seem that this particular system is meant to deliver a "shock" due to abnormal rhythm, which I believe any and all arrythmias including a-fib fall into. If it is not programmed to pick up the a-fib and deliver a shock due to it then the way I interpret the above it would not do so whether the button is pushed or not as it would simply say an electrical shock is not needed.

                        If I am wrong, so be it, but as with many other writings it is left open to interpretation with very little real information.

                        By the way, one more question, if this "system", ICD and hand device are so good why aren't more EPs offering them and why haven't more people either have them or at least heard of them?

                        Comment


                        • #13
                          Re: Self cardioversion

                          Marian,
                          In general ICDs aren't able to administer therapy for afib. Designing an ICD that can accurately detect afib and deliver an appropriate shock is not simple to do, though it's been the subject of a fair bit of research. The summaries that are easy to get from the FDA often say simplified things like "abnormal rhythm," but the reality is that ICDs are mainly designed to treat very particular sorts of abnormal rhythms. It happens that most of what they can do involves the most serious risks of sudden death - which is a good thing - but the current generation of devices can't protect against all dangerous rhythms.

                          Gordon
                          Myectomy on Feb. 5, 2007.

                          Comment


                          • #14
                            Re: Self cardioversion

                            Correct - They look for specific types of irregularities that lead into serious situations. By doing so, they reserve power where its needed most. It they were to monitor and treat Afib, they may only last a couple of years for some folks. One thing I tell newbies who have one is to ask their tech to show them examples of ventricle vs atrial fibrillation when they have there bi-yearly exams. By learning (feeling) the difference we be come better able to identify when this happens.
                            Marc
                            Diagnosed @ 48
                            Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
                            Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
                            AICD - Valentines Day '08, Spark Plug replaced 11/14
                            After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
                            Quietly going insane . . .

                            Comment


                            • #15
                              Re: Self cardioversion

                              I'm sorry if I wasn't clear before. I meant that most devices can detect afib but sometimes they try to deliver a therapy that isn't appropriate for afib. When they reprogram these devices they tell them to ignore the afib and to look for other arrhythmias instead.
                              Reenie

                              ****************
                              Husband has HCM.
                              3 kids - ages 23, 21, & 19. All presently clear of HCM.

                              Comment

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