Beat goes on: Tiny new pacemaker is a big improvement

The American College of Cardiology says approximately 200,000 American will have a pacemaker implanted in their chest this year as a result of one specific type of arrhythmia or irregular heartbeat called “bradycardia,” which is a heartbeat that’s too slow.

Dr. Vikranth Gongidi, a cardiologist at the Cleveland Clinic Indian River Hospital, has some good news for people with this type of heart problem.

There’s a new, improved pacemaker by Medtronics called the Micra that works well for the condition.

According to the Memorial Hermann Heart and Vascular Institute in Houston, “if the heart rate is too slow, not enough blood reaches the brain, and the person can lose consciousness. For most adults, a heart rate slower than 60 beats per minute is a bradyarrhythmia.”

For people who are very physically fit, this heart rate might not be dangerous, but for others “it’s a serious health condition.”

Pacemakers, which have been around in one form or another since 1958, are “small devices that are placed in the chest or abdomen to help control abnormal heart rhythms. These devices use electrical pulses to prompt the heart to beat at a normal rate,” according to the National Institutes of Health.

That said, what was small in 1958 seems enormous now. The first commercially available pacemakers were about the size of a large bar of Ivory soap and featured steel handles or loops on either side so a leather strap could be used to hold them in place around the patients’ chest. They were not implanted.

The Micra device is much, much smaller and therefore far easier to place inside not just the chest but the heart itself.

Roughly the size of a large vitamin capsule, this new-generation device boasts other serious advantages as well, according to Gongidi.

For starters, it has no “leads” or wires running to the heart.

The American College of Cardiology points out that those electrical leads “are considered the weakest link of any pacing system. The majority of pacemaker complications are related to lead placement.”

The Micra has no wire leads because, thanks to its small size, it is implanted directly into the heart.

Another issue with those electrical leads, Gongidi explains, has been recalls. “Over the last few years [there has been a major problem with] the leads of pacemakers having fractures in them. There have been a lot of recalls and that causes a lot of anxiety with patients” who have those devices in their chest.

Another advantage of the Micra is that implanting it does not involve cutting into the chest.

As Medtronics explains, “the Micra is placed into the heart via a catheter inserted in a vein in the leg, thus no chest incisions, no scars and no bumps” like those that can result from implanting conventional pacemakers.

And while it didn’t matter much in 1958, Gongidi points out the Micra pacemakers “are FDA-approved for magnetic resonance imaging or MRIs,” though he adds that you can’t have an MRI immediately after a Micra is implanted.

“You’d have to wait at least four to six weeks for the device to fully imbed,” he says. But that is a big improvement compared to older pacemakers. For patients with earlier generation pacemakers, MRI exams are strictly off limits.

And then there’s battery life.

While the National Heart, Lung and Blood Institute says the average pacemaker battery has an expected life of about six-to-seven years, Gongidi says the Micra’s battery should last “10-to-12 years.”

“These Micra pacemakers have been around for a little over a year but they’re not being implanted in many facilities. We are the only ones here in this county,” Gongidi says, who are implanting the Micra.

Gongidi’s colleague, electro-physiologist Dr. Brett Faulknier, handles the implantation process, and according to Gongidi, “the recovery is usually a few days, whereas if you have a traditional pacemaker implanted you can’t use [your] arm for at least four to six weeks.” No golf and no bowling. But with the Micra, “you can go play golf within two or three days.”

Is the Micra pacemaker the right choice for you? Gongidi suggests you consult your cardiologist. He or she will know your specific heart situation and be able to offer sound advice.

Dr. Vikranth Gongidi is with Cleveland Clinic Indian River Hospital. He has offices at 3450 11th Court in Vero Beach and 801 Wellness Way in Sebastian. The phone number is 772-778-8687.

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