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Heart-beating progress in new micro pacemakers

March 2018

pacemaker

Nearly 500 pacemakers are fitted with a pacemaker each week, or around 25,000 a year. That is a staggering number and clearly indicates the importance of these amazing little machines.

The UK was one of the first countries in the world to start implanting these little devices, although the early devices actually had to be plugged into mains electricity. But progress was fast with new technology and tiny batteries and by 2009 more than half a million pacemaker operations were carried out in the UK.

Today having a pacemaker fitted is considered quite a normal procedure. It is used to treat problems when the heart is beating abnormally, perhaps too slowly or is missing beats. The formal term for this is arrhythmia and it really is surprisingly common.

A pacemaker works by taking over the action of the sinus node in your heart, which is your natural pacemaker. The pacemaker sends out electrical impulses to stimulate the heart to contract and produce a regular heartbeat. The pacemaker can be programmed to send out regular impulses at a fixed rate, or to work just when a problem is identified in the heart beat. It is not an electrical shock, simply a small electrical impulse.

There are today different types of pacemakers including those designed for a single chamber with one lead, dual chamber with two leads or biventricular pacemakers with three leads, connecting to the heart through a vein. Most pacemakers are very small, less in size than an average matchbox, and they weigh only around 20 to 50 grams.

Surprisingly they are quite easy to fit and often can be put in under a local anaesthetic with sedation.
They are fitted just under the collarbone and serious complications from the insertion of a pacemaker are today quite rare. Most people get back to normal life quite quickly after having a pacemaker fitted, and can often forget they have one. The only time to really look out is when you are going through airport or other security magnetic devices.

A couple of years ago a new type of pacemaker was developed which is much smaller and also without leads. Called Micra, it doesn’t have leads but is implanted directly into the patient’s heart via a vein in the leg. This means there is no chest incision, scar or bumps that can sometimes occur with a traditional pacemaker. Being self contained within the heart, it also eliminates potential medical complications from the chest incision. There is also less risk of the pacemaker becoming infected because there are no leads in the veins and no generator in the chest. It can also be implanted in patients whose veins to the heart are narrowed or blocked.

The Micra is tiny, 93% smaller than the traditional pacemakers, really just the size of a large vitamin capsule. It was approved for use in America by the FDA and has since been used by a number of Trusts in the UK including Imperial College Healthcare NHS Trust.

Last May the first study in the use of the tiny leadless pacemakers in real patient settings was carried out by Southampton University. The results show a high implant success rate and a low risk of major complications in the first 30 days.

All in all, pacemakers have come a long way from their early beginnings and are now almost treated as routine by many medical professionals. There is lots of information on the internet, but if you Google it incorrectly, you can also find out a lot about that band we used to love in our youth, Gerry and the Pacemakers!


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