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A win for Cape Town hospital using minimally invasive technique to insert world’s smallest pacemaker

Specialist cardiac unit at Vincent Pallotti. Picture supplied

Specialist cardiac unit at Vincent Pallotti. Picture supplied

Published Dec 1, 2022


Life Vincent Pallotti Hospital’s specialist cardiac unit has inserted the world’s smallest, leadless pacemaker, self-contained within the heart and 93% smaller than conventional pacemakers.

A pacemaker is a medical device that is implanted in people whose heartbeats are too slow to help maintain a regular heartbeat.

Dr Vinod Thomas, an electrophysiologist and cardiologist, is the first interventional cardiac expert to undertake this minimally invasive technique inside the Life Healthcare Group.

Instead of requiring a chest incision as a typical pacemaker would, the small Micra pacemaker is the size of a large vitamin capsule and is inserted into the heart through a vein in the leg. This indicates that there are no outward indications of a medical device present beneath the skin as you would normally see with someone who has a pacemaker.

“We essentially insert a straw-like catheter system into a vein, typically near the upper thigh area of your leg. The catheter system moves the Micra pacemaker into the right ventricle of the heart. It is secured against the heart wall and tested to ensure it is working properly. We then remove the catheter system,” Thomas said.

He says this most recent treatment broadens the cardiac unit’s capabilities and the device removes potential health risks associated with a chest incision from wires running from a traditional pacemaker into the heart.

Thomas points out that the device is designed for patients with particular pacing demands and results in fewer post-implant activity restrictions and no shoulder movement restrictions.

“As with all medical procedures, there are benefits and risks involved. Patients should discuss these with their doctor,” he said.

Pacemakers are implanted in people with slow cardiac rhythms to deliver electrical impulses that cause the heart to contract. To implant a pacemaker using traditional methods, a “pocket” must be made under the skin directly below the collarbone. Wires are then implanted through a shoulder vein into one, two, or three of the heart’s four chambers, depending on the exact rhythm issue a patient is experiencing.

“Conventional” pacemakers are still effective and efficient in ensuring a patient’s heartbeat can be controlled, but new technology and procedures such as those with the Micra device are offering clinicians and patients more options that are far less invasive, Thomas says.

How is the Micra heart pace different from the conventional pacemaker?

“HIS-bundle pacing is a relatively new technology that is now available in the cardiologist’s armamentarium, in the battle against heart failure,” Thomas said.

A bundle of cardiac fibres known as the “HIS-bundle” is in charge of electrical conduction in the heart. One of the most recent advancements in pacemakers is HIS bundle pacing, which uses a conventional pacemaker with a specific screw-on lead to pace the heart via the HIS bundle to electrically connect the upper and lower chambers of the heart.

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