It might sound bizarre, but new research suggests that patients may be able to make the most informed decisions about whether or not to have a pacemaker permanently implanted by “test driving” the devices first.

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The “test drive” procedure that the University of Iowa team has developed involves the patient using the pacemaker outside of their skin before they make the decision on whether to have a permanent implant.

Researchers from the University of Iowa in Iowa City presented their findings at the joint meeting of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) and Cardiostim in Milan, Italy.

The “test drive” procedure that the University of Iowa team has developed involves the patient using the pacemaker outside of their skin before they make the decision on whether to have a permanent implant.

The technique was initially developed for patients who were already using pacemakers but had to have them removed to treat infections. To do this, it was necessary for the pacemaker hardware to be removed from the patients’ bodies while antibiotics cleared the infection.

“We would give them what we call a temporary permanent pacemaker,” explains Prof. Michael Giudici, director of arrhythmia services in the Department of Internal Medicine at the University of Iowa. “You use a permanent pacemaker and a permanent pacing lead but the device is just on the outside of the body.”

“In symptomatic patients with slow heart rates it’s hard to know for sure that the reason these people feel poorly is because their heart is slow,” Prof. Giudici continues. “This was a nice way to test the hypothesis that your slow heart is causing your problem without committing them to a surgery and a permanent pacemaker.”

Six patients voluntarily underwent a 2-3-week test drive to decide for themselves how beneficial implantation with a pacemaker might be for them. The patients were aged between 40 and 82 years, and the procedures took place over a period of nearly 4 years.

In the procedures, a needle was placed into the subclavian or axillary vein, with leads attached to a nonsterile permanent pacemaker that was sewn to the skin and covered with a waterproof dressing. After 2-3 weeks of the pacemaker being attached to and set to an appropriate heart rate for each patient, the device was removed.

The researchers report that no complications were associated with the implantation, trial period or removal of the device during the test drives, and that all six patients subsequently chose to have a pacemaker permanently implanted. The patients also reported improvements in exercise tolerance, quality of life and alertness.

“The test drive enables patients to go into their procedure much more confident that the pacemaker is going to do them some good,” Prof. Giudici says. “It also allows the patient to make the choice, which ultimately makes them much happier than if the doctor just tells them they need it.”

Prof. Giudici adds that patients may be worried about body image issues associated with pacemaker implantation, as there may be some discoloration of the skin and a visible lump. “There are also issues with simply having a device inside the body, ‘Am I getting old?’ and ‘Do I have a heart problem?'”

“By doing this procedure we allow the patient to see the before and after, so they can make a much more informed decision,” he says.

Last year, Medical News Today reported that a patient in the UK had become the recipient of the world’s smallest pacemaker.