Pacemaker and Device Management

Dr Mariani manages cardiac implantable electrical devices. This umbrella term incorporates pacemakers, loop recorders, implantable cardioverter defibrillators and cardiac resynchronisation devices (biventricular pacemakers and defibrillators). Newer devices are also emerging and this includes leadless pacemakers, subcutaneous defibrillators (S-ICD), and wearable defibrillators (Lifevest).

Management of the devices includes implanting the devices, managing the devices after implantation, and troubleshooting. He runs his own clinics in his rooms, at offsite clinics (Reservoir and Bairnsdale), along with dedicated pacemaker clinic at The Alfred. Devices that Dr Mariani monitors are Biotronik, Boston Scientific, Medtronic and St Jude Medical (there is no capacity to monitor a Sorin device).

Information about Pacemakers and Defibrillators

In this section, there is downloadable information regarding pacemakers and defibrillators.

Pacemakers (from Heart Rhythm Society) -
Download PDF here
Implantable Defibrillators (from Heart Rhythm Society) -
Download PDF here

The Patient Resource Section of Heart Rhythm Society has useful information.
Click here to go to the HRS website.

Living with a Pacemaker or Defibrillator

Patients with pacemakers and defibrillators can have normal lives. The device is often not an impediment to life. Patients can travel, drive, work, play sport and do most things. Each situation is different, and best discussed with the cardiologist.

Included is a downloadable paper we wrote for GPs in an Australian medical journal. It's written for the doctors, but patients and their families may find it useful, especially the tables and guidelines that are provided.

Download the PDF here of our paper: Managing patients after implantation of a cardiac rhythm management device.

Car and licence requirements can impact on patients after device implantation. Guidelines are offered by
Austroads - in the form of a publication called "Assessing Fitness to Drive". The relevant table can be accessed from this link.

Remote Monitoring of Cardiac Implantable Electrical Devices

Dr Mariani also actively uses available technology the facilitate management of these devices for patients. This technology uses Remote Monitoring - this is a way for an implanted device to communicate with a cardiologist using a small monitor. It allows regular connection to a cardiologist, reducing the number of clinic visits and allowing earlier detection and management of changes (detected by the device) that may be life threatening - before the patient is aware there is an issue.

In order to provide a comprehensive service, and mindful that Medicare only covers two remote checks per annum, Dr Mariani has engaged Nick Youngs, cardiac tech, to provide the remote monitoring service. Nick monitors over 450 patients for Dr Mariani from Melbourne, rural Victoria and interstate. Nick also covers other cardiologists practices.

Nick can be contacted through his company website:
Remote Rhythm Management.