Worlds smallest pacemaker implanted at Mediclinic Panorama

Posted on 19 October 2016

On Monday 17 October 2016 Dr Razeen Gopal, Cardiac Electrophysiologist at the Cape Town Atrial Fibrillation Centre located in Mediclinic Panorama, percutaneously inserted the world’s smallest pacemaker into the heart of Mrs Joan van Niekerk (74) from Brackenfell.

Dr Gopal performed three more implantations to complete the first post FDA-approval series of commercial intracardiac pacemaker implants in Africa on Tuesday 18 October 2016.

Cosmetically invisible

The minute pacemaker is entirely leadless, and at 6.7mm in diameter and 25.9mm in length is only one-tenth the size of an ordinary pacemaker. It is implanted directly in the right ventricle of the heart.

The Medtronic Micra® Transcatheter Pacing System (TPS) is the first FDA approved product with miniaturised pacing technology.

‘It is cosmetically invisible and is small enough to be delivered through a catheter via the femoral vein in the groin and implanted directly into the right ventricle of the heart, providing a safe alternative to conventional pacemakers without the complications associated with cardiac wires,’ explains Dr Gopal.

Comparable to the size of a large vitamin, the small intracardiac pacemaker is attached to the heart with small tines and this allows it to deliver electrical pulses that pace the heart through an electrode at the end of the device.

The pacemaker is inserted into the right ventricle (thus first passing through the right atrium and the tricuspid valve), where it is carefully and specifically placed at the bottom part of the right ventricle, and attached to the thick part of the septum between the two ventricles.

Automatically adjusts therapy

Unlike traditional pacemakers, it does not require leads or a surgical ‘pocket’ under the skin, eliminating potential sources of complications related to such leads or pockets, the most feared being infection.

The device responds to patients’ activity levels by automatically adjusting therapy. In fact the diminutive pacemaker is a rate-responsive device with a very sophisticated built-in accelerometer that can distinguish between the heart’s own natural beating rhythm and the movements of the patient.

‘It is the first and only transcatheter system to be approved for both 1.5 and 3 Tesla full-body magnetic resonance imaging (MRI) scans, providing patients with access to the most advanced imaging diagnostic procedures available,’ says Dr Gopal.

10-year battery life

While the device is designed to be left in the body, the design does incorporate a retrieval feature should this be necessary. The average battery life of the device is about 10 years, and a second or even a third device can be placed in the right ventricle if necessary in future.

Mediclinic Panorama Hospital General Manager, Riaan Vorster, reinforces the importance of such a procedure.

‘It is important for our patients that they can benefit from such technology; the research has shown that the intracardiac pacemaker has very low complication rates and that there was a significant reduction in healthcare utilisation compared to traditional pacemaking systems. We need to offer solutions that are going to positively impact our patients’ lifestyles.’

‘Mediclinic is always investigating how the needs of our patients can be answered through innovation and we believe that Dr Gopal’s introduction of this technology into our hospital is one of these remarkable situations,’ Vorster concludes.

Published in Innovation