Cutting Edge

July 11, 2017
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Patients with a single-chamber pacemaker may now have a new option to help regulate their heart rhythm.  In April, CAMC implanted the first leadless pacemaker in West Virginia - an innovative technology that can eliminate potential complications of traditional pacemakers and allow patients to avoid major surgery for implantation.

A healthy heart automatically regulates its own rhythm.  It keeps pace all on its own, pumping blood in and out to power the body.  Unfortunately, some hearts beat too slowly or have an irregular rhythm.  When this happens, doctors often recommend use of a pacemaker - a small device that sends electrical signals to the heart to regulate its rhythm.

"Pacemakers are given to cardiac patients who have slow heart rhythm, and they may experience symptoms such as tiredness, fatigue, lack of energy," said Chafik Assal, MD, medical director of electrophysiology at CAMC and WVU Physicians of Charleston.  "The leadless device emits impulses to make the heart beat faster, thus improving those symptoms."

Conventional pacemakers consist of a battery that is placed near the heart, often under the collarbone, with wires that are connected to different areas of the heart muscle, depending on the type of arrhythmia, to regulate the heartbeat.  The battery emits an electrical signal through the wires, causing the heart to pump.

Traditional pacemakers, while still effective and widely-used, can present complications.  The incision in the chest causes an increased risk of infection and bleeding, as well as cosmetic concerns like scars and lumps under the skin from the implantation procedure.  The most common issues, however, involve the wires that connect the battery to the heart.

"This lead has been the weak link in the pacemakers because it can fracture over time, it can get infected and would need to be removed," Assal said.  "That's why science and technology have been trying to come up with a technology that avoids the need for a lead, or a wire, like that."

After many years of research, science has done just that.  Approved by the Food and Drug Administration (FDA) in 2016, the new leadless pacemaker is implanted directly in the heart.  The implant is much smaller than traditional pacemakers - about the size of a multivitamin.  Instead of wires, the pacemaker attaches to the heart muscle using small fins that emit the electrical signal required to make the heart pump.

As opposed to placing the battery and wires in the chest wall through an incision, the surgery to implant the leadless pacemaker involves running a catheter up the femoral artery in the leg.  This means there is no major surgery, or any scar or bump as a result of the implant.  It is completely self-contained within the heart, which eliminates potential for complications and improves recovery time for the patient.

"The battery lasts for up to 12 years so patients will not need a new device for a long time," Assal said.  "In fact, after 12 years, if they were to need a new pacemaker, an entirely new pacemaker this size can be implanted in the heart without removing the old one because it's so small."

Not all patients are candidates for the leadless pacemaker.  Currently, only patients with single chamber pacemakers - those with wires that connect to only one area of the heart - can receive the new device.  But Assal is optimistic that technology will soon progress to create leadless devices to replace dual and triple chamber traditional pacemakers.

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