So many things my doctor and Medtronic didn’t tell me: A defibrillator wire defect

Stephanie Martinson, 35, a speech pathologist in Palo Alto, California, said that in March she had a defective wire – a Fidelis lead - removed from the defibrillator device in her heart. The removal was necessary because instead of correctly monitoring her heart rhythm, and only shocking it back into a normal pattern when needed, the Medtronic device had delivered a jolting shock 26 times in an hour. Medtronic notified doctors of the defect, and in May, she received a replacement wire. Unfortunately, the replacement was another Fidelis lead, which may be defective.

"There are so many things my doctors and Medtronic didn't tell me," she said.

Five patients are known to have died because of malfunctions of the device's leads, or wires, which connect the device to the heart.

Medtronic disclosed that the new thin leads have a tendency to form small cracks in the wire, which either blocks or distorts its electrical flow. The flaws may result in faulty signals to the defibrillator, making it unnecessarily shock the heart or fail to deliver a life-saving jolt of electricity when needed.

No one knows how common this problem is. Medtronic says it might affect 2.3% of the 235,000 patients who have the suspect wires, i.e., more than 5,000 patients.

Advice: Tell your friends with implanted defibrillators to ask their doctors whether they have the Medtronic-made Fidelis leads (which have identifying numbers 6930, 6931, 6948 and 6949, on their wallet card), and if so, to schedule computerized testing of the device.

Read another defibrillator story, or read the source stories by Barry Meier and Lawrence Altman in today's New York Times.

A doctor’s visit that changed history: An empowered patient

Boris Yeltsin was running for re-election as the first President of Russia. But he had had a heart attack, and was having chest pain. A Russian surgeon said the 65-year old leader wouldn’t survive the coronary bypass surgery he needed.

Yeltsin, the second most powerful man in the world, was clearly an empowered patientt. He asked for a second opinion—from Dr. Michael DeBakey. DeBakey was confident that an excellent Russian surgeon, Dr. Renat Akchurin, could safely perform the operation. Yeltsin’s medical team followed DeBakey’s advice to correct thyroid and other problems to prepare him for the bypass, then performed the surgery competently.

"All the doctors agreed Yeltsin would have died if he did not have the bypass. He was deteriorating and going into early heart failure," DeBakey said in an interview. "We gave him 10 ½ years of comfortable life."

"I’ll do what you say if you can put me back in my office," Yeltsin had told Dr. DeBakey. As a patient, Yeltsin "was not as bossy as he was with some of his Russian doctors," DeBakey said, adding, "He didn’t get along with some of the doctors there. But he took a liking to me, listened, and that made things much better."

Advice: Be like Boris: Listen to your doctor, and do what he or she says, even if you usually give orders rather than take them. Use your connections, or those of your advocate, to get a sound second opinion.

Then use your extra years of life to change the world – in a better direction than he did, picking a dictatorial former spy chief, Vladimir Putin, as his successor.

Read another of our world-changing medical stories, or Dr. Lawrence Altman’s source story in the May 1 issue of The New York Times.