Product summary

Dual chamber pacemaker in action. The blue side is the right heart. The atrial lead will fire first (notice the blue spark), followed by the ventricular lead (blue spark).


NASPE/BPEG code for pacemakers.
Typically only the first 4 letters are used. The fifth letter is only used in the case of triple chamber devices, see CRT.

• Talos S and Philos II S are single chamber devices, typically implanted with a ventricular lead (VVI configuration), occasionally with an atrial lead (AAI configuration). The Philos II S offers automatic capture control to automatically adjust the amplitude of the pacing pulse, thus saving battery and extending service life. It also has rate smoothing to ease the symptoms of atrial fibrillation. 
• Talos SR (AAIR/VVIR) provides rate adaptation. It also offers automatic capture control. 
• Talos D (DDD): basic dual chamber device with automatic capture control. 
• Talos DR (DDDR): dual chamber device with automatic capture control and rate adaptation. Suitable for all patients.
• Talos SLR (VDDR): a restricted version of the Talos DR which does not provide pacing in the atrium. Suitable for patient with a good sinus node and with AV conduction problem. Typically sinus node capable of 70 bpm is required. Implanted with a single lead with 4 electrodes capable of sensing in the atrium and with pacing and sensing capability in the ventricle.
• Cylos DR (DDDR). The world best dual chamber pacemaker in 2006. The only one with Closed Loop Stimulation (CLS) rate control that responds not only to activity but also to emotions. Proven to reduce atrial fibrillation burden. Ideal for older people who cannot have fast enough activities to trigger the accelerometer in the Talos DR, but who wants to have an active life. This is a premium device with premium features.


New generation of pacemalers - safe for MRI scanning

All the pacemakers below are safe for MRI scanning. They do require that the device be programmed to a safe program prior to the scan, and then reprogrammed back to the original program. These are the MR conditional pacemakers. This is the future trend for pacemaker. It is estimated that a person being implanted today with a pacemaker will likely need to undergo an MRI scan during the life of the pacemaker. Without it being MR conditional, an MRI scan may be refused, depriving the patient from a life saving diagnostic!


• ProMRI Evia DR (DDDR). This is the successor to the CLS Cylos with a complete new set of features. First of all when used with a ProMRI lead, it is an MR conditional pacemaker system. News features include: atrial autocapture, automatic sensitivity (like in defibrillators), two algorithms to reduce ventricular pacing, namely IRS+ and Vp Suppression, Program Consult (for 10 default program sets), Easy AV (to simplify programming AV delay and AV hysteresis, >12 years service life.
• ProMRI Estella DR (DDDR). Almost everything in the Evia, minus CLS. MR conditional, >12 years service life. The affordable MR conditional DR.
• ProMRI Estella SR (AAIR/VVIR). MR conditional, >15 years service life. The affordable MR conditional VR. 
• Effecta D (DDD). All the automation in the Estella DR, >12 years service life.
• Effecta S (AAI/VVI). >15 years service life. 

For MRI scanning, the whole system (pacemaker and lead) must be MR conditional. See below.

For a young patient, the selection of a high quality lead may be even more critical than that of the pacemaker. We offer one of industry's best longevity lead. While a pacemaker service life is 7-15 years, depending on how it operates, a high quality pacing lead can last 2 to 3 times as long. This is important since most cardiologists will leave the lead in the body should it become defective, clogging the vein of the patient. The cumulative survival rate of the Polyrox lead that we have been selling in Vietnam for a number of years is shown in the graph below. None of the competing leads in Vietnam can boast such survival rate.

Polyrox survival probability.
Extract from Biotronik performance reports.

We have moved on to the Selox family of leads with very good survival rate.

Selox survival probablity
Extract from Biotronik performance reports.

The newer lead family in use right now are

• Setrox S. This is a very flexible lead that bends when the heart contract. It is well suited for the latest implant technique of implanting leads in the ventricular septum. It uses a 7 French introducer (1 French = 0.33mm).

As with all Biotronik leads, the electrodes have an Iridium fractal coating to increase the interface surface area to yield excellent signals. With the large signals achiveable,   the surface areas of the electrodes can be decreased to achieve low pacing thresholds and high impedances, desirable pacing characteristics. This electrode surface treatment is available only on Biotronik electrodes. Such a surface treatment makes Biotronik leads ideally suited for the automatic amplitude control algorithm used in newer generation pacemakers.

• Siello S, T and JT. This is the latest generation of leads which require 6 French introducers. In spite of its smaller diameter, the insulation thickness of the Siello lead is the same as the one of the Setrox lead and the bigger Selox SR lead, thus ensuring that this is a safe lead resistant to wear and tear.

The MR conditional leads are the Safio S (7F) and Solia S (6F) and Solia T (6F) which are externally and handling-wise similar to the Setrox and Siello leads.

So, why not use the best?

Implantable cardioverter-defibrillator

ICDs are devices used to treat patients with life threatening fast heart rate, namely ventricular fibrillation. We offer the following products:

Lumax 300 VR-T Single chamber ventricular ICD	Lumax 340 VR-T XL 10 year full service life ventricular ICD	Lumax 300 DR-T Dual chamber ventricular ICD	Lumax 300 HF-T Triple chamber ventricular ICD
Lumax 540 DR-T Dual chamber ventricular ICD 10 year life	Kentrox SL Shock lead	Linox SD Shock lead	CardioMessenger Home Monitoring

All the above devices provide ventricular tachyarrhythmia (fast heart rhythm) therapy and either single, dual or triple chamber bradycardia (slow heart rate, see pacemaker above) therapy.

The main device is the Lumax 300 VR-T with a 1,28 Ah battery, larger than the competition. The Lumax 340 VR-T XL is a full featured (all therapy features by default are ON) with 40 Joule (the other devices are only 30 Joules) shock capability and 10 years of service life thanks to a 1,72 Ah battery.  The Lumax 300 DR-T is the dual chamber ICD, with a 1,28 Ah battery. The Lumax 300 HF-T is the  triple chamber ICD, the CRT-D, with the large 1,72 Ah battery. 

Other Biotronik defibrillators we can order for patients who need to replace their defibrillator with a device that matches their original ones, are

• single chamber: Lumax 340 VR-T with a 1,28 Ah battery and 40 Joules shock; Lumax 540 VR-T with 1,72 Ah battery and 40 Joules shock.
• dual chamber Lumax 340 DR-T with a 1,28 Ah battery and 40 Joules shock; Lumax 540 DR-T with 1,72 Ah battery and 40 Joules shock.
• triple chamber Lumax 340 HF-T with a 1,72 Ah battery and 40 Joules shock; Lumax 540 HF-T with a 1,72 Ah battery and 40 Joules shock.

For ICDs in the same generation, i.e. the year of product introduction, Biotronik ICDs lead others in the following

• Thickness. Biotronik are typically thinner than others. The Lumax 300 are 12 mm thin. The 340 and 540 devices are 13 mm thin.
• ATP-One-Shot therapy for the fastest rate lethal ventricular arrythmia, ventricular fibrillation. If the rhythm is stable, the device will deliver a painless bursts of pacing and immediately start charging for a shock. In clinical studies, ATP-One-Shot is successful in breaking over 2/3 of these episodes of very rapid arrhythmia which in previous generations of defibrillators would have been treated with painful shocks. According to the studies done by Dr Sweeney, ATP-One-Shot can decrease your risk, since patients who receive shocks tend to have a shorter life than those who don't.
• The largest memory available for storing electrograms. This is a key diagnostic capability. 32 s of pre-episode electrogram can help your cardiologist adjust your medication to prevent recurrence of the tachyarrhythmia episode. Length of electrogram helps understand the progression of the arrhythmia during therapy progress and again helps your cardiologist adjust the ICD parameters for optimal and less painful therapy.
• Number of channels. Lumax DR, HF-T: 3 channels. All other: 2 channels.
• Duration: 32 minutes;
• Pre-storage: up to 30 s;

In general dual chamber devices are implanted because either the patient requires pacing due to slow heart rate or because the patient has episodes of ventricular tachycardia (an organized high rate ventricular rhythm that reduces blood circulation and thus requires therapy). A single chamber device has a high probability of misdiagnosing a supraventricular (above the ventricle) tachyarrhythmia, which normally does not require therapy because it is typically not life threatening, for an episode of ventricular tachycardia leading to therapy being delivered in the ventricle causing pain and possibly generating an episode of ventricular tachycardia or ventricular fibrillation. All the Biotronik dual and triple chamber ICDs use the SMART Detection discrimination algorithm to prevent inappropriate therapy from being delivered. This algorithm was developed by Dr. Tran Thong, the founder of Northwest and Systolic, and his engineers at Biotronik, and is currently the best discrimination algorithm with sensitivity (ability to detect a ventricular tachyarrhythmia) of 100%, and a specificity (ability to hold off therapy when not a ventricular tachyarrhythmia) of 93-97%. A single chamber ICD typically has specificity in the 50-75% range, thus delivers a lot of inappropriate therapies, especially painful shocks, in patients with ventricular tachycardia! This is one of the reasons why over half of the ICD implants in the US are dual chamber devices! In the recent report on the ALTITUDE study, shock therapy of atrial fibrillation can increase your mortality risk by 61%, when compared to no shock. Thus, you owe it to yourself to have the best discrimination algorithm in your dual chamber defibrillator.

Smart Detection diagram. Simple but very effective!

For patients who require pacing, we highly recommend the dual chamber Biotronik defibrillators above. All the Biotronik dual chamber pacemakers and defibrillators support the IRS+ algorithm for reduced ventricular pacing. This is similar to the algorithm used in the INTRINSIC RV clinical study which showed that dual chamber pacing with an algorithm similar to IRS+ to reduce ventricular pacing can actually reduce incidences of heart failure. In Vietnam, the reduction demonstrated in INTRINSIC RV can only be achieved with Biotronik dual chamber devices. The ventricular pace reduction algorithm used in all the competing devices are different from the one in this study!

The shock lead used with our devices, the Kentrox SL, has an excellent survival record, still unmatched by its competitor.

Kentrox SL survival probability.
Extract from Biotronik performance reports.

Linox is the successor to the Kentrox. Requiring only an 8 French introducer, this is an extremely flexible lead with a soft lead tip designed to minimized dammage to the heart, a problem that has plagged other leads. With its flat wire technology (ProTek) to minimize fibrosis, the lead can be removed more easily should this become necessary at some time in the future. It also has one of the thickest insulation making it the safest lead in the industry. 

Linox very flexible lead allows it to flex with each heart beat and not dammage the heart.

Linox soft tip reduces pressure on the heart. It also help speed implant since the cardiologist can make pacing measurements prior to deploying the screw.

Protek design of all Biotronik shock leads (already in Kentrox) increases energy delivery and minimizes fibrosis, simplifying lead removal should this become necessary.

Insulation thickness. The lead on the right has been recalled due to wire break and the company is now supplying a much thicker lead. The lead on the left is no longer sold due to insulation wear both from the outside and more seriously from the inside.

Why play Russian roulette with your defibrillation lead. Use the one that has been the safest!

Home Monitoring

A new feature which has become available in Vietnam since mid 2011 is the Biotronik Home Monitoring. In all of Southeast Asia, you can get Home Monitoring (HM) only from Systolic Medical. All the Lumax family of defibrillator are HM enabled. You will need to buy a CardioMessenger (see picture above), a dedicated cellular phone that relays message from your defibrillator to the monitoring center in Germany. Each night the defibrillator transmit a full report of the functioning of the device to the center. This is made available on the internet to the monitor engineer of Systolic Medical, with 18 years of experience with Biotronik defibrillators. He will monitor everyday and if an event, that you, the patient, may not even be aware of, happens, he will be in contact with your designated cardiologist for a more detailed followup. An example of a patient with a history of significant arrhythmia that has been successfully treated is available at this website. The page is in Vietnamese, but just looking at the top graph, you can understand how successful it has been.
For non-Vietnamese patients, a defibrillator with Home Monitoring is ideal. If you have been implanted a Biotronik Lumax defibrillator in Southeast Asia, and Home Monitoring is not available in your home country, you can come to Vietnam and we will be glad to set you up with it. As you are monitored, if an event is reported, your personal cardiologist in your home country can be informed with recommendation about what changes in programming would be required. If interested, please contact us at lienlac@systolicvn.com.
Home Monitoring just requires that at home you have access to a 3G cellular network. Actually you need only the GPRS capability of a 2.5G network. If you have an iPhone and can surf the net, Home Monitoring will work.

Cardiac Resynchronization therapy

Stratos LV-T	Lumax 300 HF-T

For the left atrial lead, we use the Corox OTW bipolar lead, with its unique 3D spiral shape to adhere securely to the coronary veins. A new addition, appropriate for patients with small veins, is the -S version shown below, with a silicone screw thread at the far end.

Sudden cardiac death risk stratification

An overview of micro-Volt T-wave alternans in Vietnamese is available.


While this is not a product that we would market directly to patients, we would like to to refer patients who meet the following indications

• 3+ month survivor of a heart attack
• chronic heart failure with a left ventricular ejection fraction (LVEF) of less than 40% ... a normal heart has an LVEF > 50%
• who does not have atrial fibrillation
• who has a narrow (<120 ms) QRS ... if you have a wide QRS, you are likely a candidate for Cardiac Resynchronization therapy (see section above)

For our visitors from Cambodia and Laos

A clinic in Phnom-Penh is implanting single chamber devices. We have a large number of customers who have come to Vietnam from Laos and Cambodia for device implant. If you have a cardiac rhythm problem and believe you need to implant a device and would like to come to Vietnam, we can make arrangements for you to be examined by a Vietnamese cardiologist and to receive an implant, if needed. The Biotronik devices have a worldwide warranty. The cost of Vietnamese care is less than what it would cost you in Singapore or Thailand. Please feel free to contact us at nwspi@comcast.net

For our visitors from the US

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The US is one of the few major countries without universal health insurance. If you are a US resident, in particular a Vietnamese-American, not covered by medical insurance and have been diagnosed to need a pacemaker/defibrillator implant, the alternative to an expensive US procedure is to come back for a vacation to Vietnam and have a Vietnamese cardiologist examine you and if needed, implant a device. The cost of the trip, the exams and implant of a top of the line pacemaker, for example the Cylos DR, is significantly less than what a basic device alone would cost you in the US. And why not an upgraded system which is also MR compatible, namely the Evia DR pacemaker and a pair of Solia leads. If you need a defibrillator, a Lumax 540 DR-T with Home Monitoring is the best system you can get anywhere in the world. High marketing cost in the US is the cause for the high implant cost in the US, on top of medical malpractice insurances. The Biotronik devices have a worldwide warranty and can be followed at US clinics, if needed. If you have a need for such a device, please feel free to contact us at nwspi@comcast.net and we can provide you with the introduction to a Vietnamese hospital close to where your relatives/friends live in Vietnam. If you prefer to stay at one of the excellent private clinics, and the clinic does not have the appropriate cardiologist on their staff, we can make arrangements for you to have an experienced cardiologist from a nearby implanting hospital come and perform the implant, and follow you during your stay. Follow-ups in the US and Europe are not a problem since a number of our patients in Vietnam have emigrated to the US and Europe and they have not experienced any problem having their devices monitored at US and European clinics.

If you already have a US cardiologist, you can still come to Vietnam for the implant of a defibrillator or triple chamber device, and then visit your local cardiologist for any needed follow-up. Your cardiologist should have the equipment provided by Biotronik to perform any needed follow-up. Again, the total cost of the implant of these advanced devices is significantly lower in Vietnam. An estimate, about 5 years ago, for the implant cost of a basic single chamber defibrillator in the US ranges from USD100K to USD150K. For that amount, you can afford to have a top of the line defibrillator implanted in Vietnam, for example the Lumax 540 DR-T or, in the case of heart failure, a Lumax 540 HF-T, the latest Biotronik dual/triple chamber ICDs, with Home Monitoring and then fly back to Vietnam every 3-6 month for follow-up, and still have cash left over!  
The most expensive devices are normally not stocked in Vietnam. But we can import on a week's notice directly from Biotronik. 

Medical Tourism

Found the following article recently. It quotes a pacemaker implant costing $7,500 in Bangkok, versus $83,600 in the US. For $7.500 you can get the MR conditional Estella DR implanted AND have a nice vacation in Vietnam! So, try Saigon, not Bangkok! And if you want absolute peace of mind, implant an Evia DR-T with Home Monitoring! You cannot get such a system in Bangkok because Home Monitoring is not available in Thailand. The Home Monitoring system will continue working once you get back to the US, or for that matter anywhere in the world where your iPhone works.

We can make arrangements for you to stay at a comfortable private clinic and we will invite the best implanter to come to the hospital to implant the device. In a couple of days time, you can be off to some beach to spend the rest of your vacation.

Sick? Find your doctor, then call a travel agent
Published Thursday, August 13, 2009

To the gentleman who listed his ailments of the past four years and anyone interested in health care, mainly the underinsured and uninsured population, please read the article, "Need Surgery? Call a Travel Agent," in the October 2008 issue of Men's Health magazine (www.menshealth.com).Type the name of the article in the search box, and you should be able to click on the five-page article.

Medical tourism patient costs are lower mainly because of hospital labor costs, administrative costs and malpractice costs.

Payments essentially are cash only at a Bangkok hospital, with health insurance being less than 15 percent. The hospital is the busiest in the world, with labor representing 17 percent of hospital revenue. In the U.S., it is almost 50 percent. In 2007, doctors treated 420,000 foreign patients from 190 nations. Among the 900 doctors, 200 are U.S.-board certified.

Ready for the bill? Here are some medical tourism treatments and prices:lumbar disc excision, $7,500, Mexico and $37,500, U.S.; angioplasty, $8,200, Bangkok and $45,200, U.S.; new knee, $6,500 India and $39,800, U.S.; spinal fuse, $13,500, India and$59,100, U.S.; new hip, $6,500, India and $42,400, U.S.; coronary-artery bypass, $8,500, India and $96,400, U.S.; and cardiac pacemaker, $7,500, Bangkok and $83,600, U.S.

Medical tourism generally involves better care, price, recovery and lower infection rate than the U.S.

Mexico anyone?  

From John Connel, Medical Tourism, CABI International, Oxfordshire, UK, 2011.

For 4,000 USD, you can get an Estella DR which is MR conditional, not just a single chamber device as seemed to be implied in the above table for India. The Estellla DR is as good or better than any pacemaker from other companies that you can implant in the US. An upgrade from the Estella is the Evia DR, and Evia DR-T with Home Monitoring. For a total bill of <15,000 USD you can get the high end devices and have a nice vacation that has saved you >50,000 USD.

Since we do not keep all high-end products (for example the Evia DR-T with Home Monitoring) in stock, please contact us when you are planning the trip so that we can be ready for you.

Systolic Medical Products

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Systolic Medical Products Import-Export Limited (Công ty trách nhiệm hữu hạn xuất nhập khẩu trang thiết bị y-tế Tâm Thu) is currently the largest supplier of cardiac rhythm management products in Vietnam. Our main implant centers are in Hanoi, Hue, Hochiminh City. We got to our current dominant position by providing

• outstanding service to our customers. For example this extensive website with over a Gigabyte of materials to help Vietnamese customers understand the underlying disease, the treatment and the therapeutic devices available. Literature is available in Vietnamese, and other languages upon request, to patients to explain the function of the device and how the patients should care for the implanted devices. Our competitors have copied our literature, but cannot match the information provided at our website.
• and outstanding support to implanting cardiologist with frequent training seminars and consultation whenever needed. In March 2008, we just finished a series of 3 training workshops in Hanoi, Hue, Hochiminh City to train cardiologists on the programming of our devices. Without the knowledge to program the devices, a top of the line device may be no better than a basic device! Dr. Tran Thong, who led the pacemaker and defibrillator design team of Biotronik, and now is a Professor of Biomedical Engineering researching heart rhythm, is available to Vietnamese cardiologists for consultation should they have any question on the devices implanted. Since he has given many seminars over the past 16 years (since 1995) delivered in Vietnamese, unlike support from other companies that is provided in English, language is no barrier for him when Vietnamese implanting cardiologists encounter a problem with an implant. No other supplier provides such support for Vietnamese cardiologists.  

So, you owe it to yourself and your health to deal with the best!


Our pacemaker implant centers in Vietnam are located at hospitals in the following cities, going from North to South,

• Viet Tri
• Hanoi
• Haiphong
• Thanh Hoa
• Vinh
• Hue
• Danang
• Quy Nhon
• Nha Trang
• Bien Hoa
• Hochiminh City
• Vung Tau
• Rach Gia

We have a couple of private and semi-public hospitals in Hochiminh City we will recommend based on their implant skills (we rate them very high) and patient service (average - still some of the best in Vietnam). Please contact us if interested. For emergency, contact us for the nearest hospitals.