Mini sized pacemaker

Doctors from a Southampton Hospital in Great Britain transplanted mini pacemaker into two patients. Specialists claim that in comparison with currently used devices it is more safe and effective. The latest invention may be a revolution for people who have to live with such device.



Implantation of the pacemaker is currently a standard procedure used, for example, in treatment of atrioventricular conduction disorders, sick sinus syndrome or symptomatic bradycardia. It is usually carried out under local anaesthesia. It involves a cut in the left subclavian area and a puncture of subclavian vein in order to implement an electrode (electrodes) to the right heart. Pacemaker, which size is like a box o matches, is placed on pectoralis muscle. The procedure usually lasts for 30-60 minutes and does not require immobilization of the patient after it. After implantation the patients are hospitalized for only a few days, however, because of initial instability of the electrodes they should reduce effort for a month since the surgery.

Introduction of a system for chronic stimulation of the heart, as other medical procedures, involves the risk of complications. Severe complications which occur in the time of 2 weeks after the procedure are perforation of the heart muscle, pneumothorax and bleeding into pleural cavity, mediastinum or pericardium. The most important late postoperative complications are infection of operative wound or pacemaker pocket, wound dehiscence, hematoma of the pocket, ulcer over pacemaker or bedsore in the pocket. These complications may have severe course because they carry a risk of endocarditis. Some of the patients complain because of pains in the area of pacemaker or upper limb even after complete heal of the wound.

The latest pacemaker is ten times smaller than those which are currently used. Such size allows for its direct introduction to the heart through catheter placed in femoral vein. Pacemaker is placed on the wall of the heart with small clips which ensure that the system is attached and electric impulses stimulating the heart are transmitted. Therefore, no surgical cuts or subcutaneous pockets are required and the potential risk of complications is eliminated. Also, endocavitary electrodes, which were the weakest component of the stimulating system, are no longer used in the new pacemaker. The percentage of their damage was over 8%. In spite of microscopic size of the batteries, the device may work continuously for 10 years.

The quality of the new device may be confirmed by the fact that after implantation of the pacemaker in the University Hospital in Southampton in Great Britain the patients were discharged from the hospital the next day after the procedure. No complications were reported and monitored electrophysiological parameters had satisfactory values.

Due to properties of the pacemaker it can be said that the new pacemaker may be also used in relatively young and active people. However, research on new pacemakers are on-going. Of course, such devices cannot be used in all heart diseases. Apart from Great Britain the pacemakers were implanted in USA and Austria. They will be introduced into common use after completion of the research in the time of one year, at earliest. Several companies work on their production.

Written by: Anna Szajerska, Karolina Gasińska, Łukasz Kurasiewicz, Jerzy Bednarski

Source:
1. Jacek Klaudel; Pacjent z rozrusznikiem serca; Choroby Serca i Naczyń. 2004, tom 1, nr 1, 51–71.
2. Jacek Lelakowski; Powikłania stałej stymulacji serca— problem o rosnącym znaczeniu; Folia Cardiologica Excerpta. 2009. tom 4, nr 2, 69–72.
3. Małecka B., Kutarski A., Pietura R, Lelakowski J., Ząbek A., Bednarek J., Małgorzata Szczerbo‑Trojanowska; Powikłania dwujamowej stałej stymulacji serca: późne ropne zakażenie loży rozrusznika z przerwaną i zapętloną elektrodą przedsionkową powikłane zatorowością płucną po przezżylnym usunięciu elektrody; Polskie Archiwum Medycyny Wewnętrznej. 2008, 118 (5).
4. http://www.welt.de/wissenschaft/innovationen/article123782226/Mini-Herzschrittmacher-wird-ohne-OP-eingesetzt.html
5. http://de.zenopa.com/news/801727784/weltweit-kleinste-schrittmacher-erhalt-erste-uk-implantation
6. http://www.linz.at/akh/presse/2013/2013AKh_10203.asp

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