The AAA pacemaker: It's the size of a small battery and takes just seven minutes to fit... so could this revolutionary device give new heart to millions?
- The first six Britons have been fit with no leads pacemaker Nanostim
- The new pacemaker is the tenth of the size of a traditional pacemaker
- It takes under ten minutes to fit, compared to the current 45 minutes
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The first six British patients have been implanted with a wireless pacemaker – smaller than an AAA battery – that is set to revolutionise the treatment of heart disease.
Standard pacemakers, which have changed little since 1958, regulate the pulse by sending electrical impulses into the heart via leads from a battery pack, implanted under the collarbone.
The Nanostim, which has no leads, is a tenth of the size of the traditional device and sits permanently in one of the chambers of the heart. It can take under ten minutes to position, compared with up to 45 minutes for an old-style pacemaker.
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It is inserted through a vein via an incision in the leg, leaving no scars, and held in place by a screw-like anchor, which grips the inner wall of the heart.
Aside from being an easier procedure, doctors hope the innovation will help eliminate complications caused by traditional pacemakers and their leads, which include infections and clots.
Maureen McCleave, 77, was one of those given the new device at St Bartholomew’s Hospital in London this month. She says: ‘I was waiting for the sedation to kick in so that the surgeon could start. Suddenly he said it was over. He had implanted a pacemaker into my heart in just seven minutes and I was completely oblivious.’
Professor Richard Schilling, who performed the procedure, says: ‘This is an incredible step. It has been dreamt about for years. I’m excited to be the first UK cardiologist to implant the device.’
Last year, more than 40,000 Britons had a pacemaker fitted. They are used to treat a variety of arrhythmias: problems with the rate or rhythm of the heartbeat.
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Revolution: The new pacemaker could change the lives of millions of heart patients
In traditional pacemakers, up to three electrical leads run into the heart. Should the pacemaker sense abnormal rhythm, an electrical pulse is delivered.
However, Prof Schilling says: ‘It is almost inevitable that some revision surgery will be performed. At most, the leads will last 15 years, so they will require replacement. Take away the box and leads and that risk of related complications is removed.’
The Nanostim is implanted directly into the heart in a minimally invasive procedure under local anaesthetic.
A small amount of sedation is given to the patient and local anaesthetic injected into the top of the leg. The pacemaker is inserted up the femoral vein in the leg within a flexible tube.
When it is in the correct position, the pacemaker – at one end of which is a screw – is carefully pushed into the wall of the heart and turned one-and-a-quarter times.
PACEMAKERS NOW EVEN SAFER AGAINST 'HOMELAND ATTACK'
Mention TV drama Homeland to cardiologists and you may elicit a weary sigh.
One episode famously featured Nicholas Brody, played by Damian Lewis, hacking into Vice President William Walden’s pacemaker to deliver a fatal shock.
Patients often ask Professor Schilling: ‘Could this really happen?’
The speculation about hacking relates to pacemakers using radio frequency – which allows communication between the device and the programmers in a clinic or hospital.
‘Every time you initiate programming you have to have a wand held physically over the pacemaker,’ he explains. ‘The patient also has to be within 6ft of a modem.’
Some pacemakers have the ability to act as a defibrillator – as Walden’s did – so arguably a homicidal doctor with all the right kit, in the same room as the patient could deliver a large painful shock. But this is unlikely to be fatal.
The Nanostim uses a different communication method – with a professional physically placing electrodes on the body – and it can’t be remotely monitored. So technically it would be even safer in such – implausible – circumstances.
‘We check it’s in a good position by tugging gently,’ says Prof Schilling.
‘Like all pacemakers, it is battery powered and contains a computer chip which monitors electrical activity. Should it sense silence, a tinyelectrical pulse is released.
‘Most patients are interested in the lack of scar and bulky pacemaker,’ he says. ‘But we are thrilled about the lack of leads.’
The chances of the device dislodging and floating free are low, says Prof Schilling.
‘Should it dislodge, it would go into the lung and could be easily retrieved. It’s so small it wouldn’t block blood flow.’
The battery lasts up to 13 years. ‘At the end of this time you can either remove and replace it, or insert another one next to it,’ says Prof Schilling.
Maureen, who lives with her husband Rod, 75, in Chingford, Essex, is of course one of the Nanostim’s biggest fans. She couldn’t even walk up the stairs without taking a rest.
She developed atrial fibrillation a decade ago and following a stroke was on medication to slow her heartbeat. But this meant that her heart rate could drop to a dangerous 40 beats per minute. When she wore a monitor for a week, it stopped 41 times for up to 4.5 seconds.
‘Usually this happened at night,’ explains Maureen. ‘But they were worried it might happen in the day and I’d hurt myself. It was exhausting. Even the slight slope walking up my road exhausted me.’
She was waiting for a normal pacemaker to be installed, but Prof Schilling thought she would be ideal for the Nanostim.
‘I was very stressed before the procedure,’ says Maureen. ‘But once I was in there it flashed past. I was able to walk to the loo later that evening. I couldn’t believe there was something in my heart.’
She is feeling much more energetic and is also sleeping soundly. ‘Before, I’d wake up at night with my heart just beating madly. That has gone. I feel so well.’
Dr Andrew Deaner, consultant cardiologist at King George Hospital, London, and BMI The London Independent, suggests a downside is the chance of blood leaking around the heart during insertion. ‘It could cause complications, but you are still avoiding problems with the wires, the bulky box and the risk of infection.’
Nanostim’s US manufacturers, St Jude Medical, say that pacemakers are being implanted on a case-by-case basis depending on the patient.
sjm.com/leadlesspacing
Read more: http://www.dailymail.co.uk/health/article-2545849/The-AAA-pacemaker-Its-size-small-battery-takes-just-seven-minutes-fit-revolutionary-device-new-hear-millions.html#ixzz2rXZiByPP
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