Leadless pacemakers - keeping pace with technology
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- Опубликовано: 2 июн 2024
- In 1971, a scientist called Spickler hypothesised that if one could stick a small device directly into the heart then we could avoid some of the problems. It has taken over 40 years for Spicklers ideas to become reality and this is largely because improvements in technology and integrated circuit boards have meant that you can now confine all the components of a pacemaker into a device of less tan 1 cubic centimetre. In 2014, the first leadless pacemaker was finally produced. There are now 2 such devices - the first is known as a MIcra and the other is called Nanostim.
Both forms of leadless pacemaker are implanted into the heart through veins in the leg. The femoral vein is punctured, a large sheath is inserted and through this a delivery catheter which holds the pacemaker is inserted and pushed all the way to the right heart under X-ray guidance and when it reaches the right spot (usually the septum of the right ventricle), the pacemaker is deployed and left in the heart and the catheter is pulled out. The micra devices has tines which attach onto the wall and therefore the device becomes securely attached to the heart and there is minimal risk of it moving.
So whilst we know that it is possible to implant these, the next question is about safety and efficacy. In 2015, the safety experience from the implantation of over 700 micra devices was published and it was noted that a successful implantation was achieved in more than 99% of patients and at 6 months, the rate of complications was 4% compared to 7.4% with traditional pacemakers. Whilst many of the complications were not dangerous, there was a 1.6% risk of cardiac perforation. This was obviously concerning and have been studied further and a later study of 1345 patients suggested that the rrisk of cardiac perforation was actually much lower at 0.37%. An important thing to note was the device infection risk was very very low with the leadless systems.
My mom was given one of the bullet shaped pacemakers that go into the heart. It has worked fabulously for her and she is now 92 years old and still hanging in there! 👍🥳🌷
We don't always have access to a cardiologist or the time during an appointment to ask the best questions. Your videos are priceless. Thank you.
They pierced my heart putting the leads in! Spent 6 days in ICU. Fine now!
This guy gave me my life back. My cardiologist gave me meds that put me in the hospital. Please people get 2nd and 3rd opinions before blindly trusting any doctors.
aww thank you!
Be aware of clinical stages of diseases before being judgmental
I'm scheduled to get one 12 March 23!!!!I I HOPE it is a great success!!
Very good to see you back! The science is amazing...I can only imagine what the future holds.
BRAVO--VERY CONCISE EXPLANATION.
Easy and Excellent talk. Thank you Sir.
Thankyou, i don't need it yet only having af now and again after one ablation but it's really nice listening to someone who doesn't lie. You are extremely well received and appreciated. And as our society's ability to communicate deteriorates due to all of our addiction to tv screens and what we all think we need more of...ill hold on to... the good whilst it's still coming..... yes..... you're the good. Thankyou for your time , it's priceless
Thank you, Sanjay! Welcome home. Great to have some new videos! 💖
I’m a recent pacemaker recipient for sudden complete heart block and developed POTS. I have learned so much from your videos. Sadly the doctors and specialists here in Australia who I’ve seen don’t seem to know much about POTS.
Good to see you again. Hope all is well with you and your family.
So good to hear from you again Dr Gupta. Interesting video.
Thank you very much doctor.
Long time no seen! So nice to have you back on RUclips ♥️
Oh wow good to see you dear Dr. 🥰
I just come here to give him thumbs up on his video this Doc is awesome help me so much with his videos
Hello Dr. have a great week for you and your family~
Great, as always. Welcome back, Doc.
That was so interesting
Thanks for posting 👍
Thanks for your advice 😍
As the (co) designer of the integrated circuit electronics in the Nanostim single chamber and dual chamber leadless pacemakers, I will say that if I had to have a pacer, given the choice, I would go with a conventional lead based unit over leadless.
Very happy to see you again.take care
Thank you very much doc, useful an entertaining. Hadn't seen you in a while.
Great video! I’d love to see a video covering what happened to Christian Eriksen in the euros
Thank you Dr, it was very useful information
Wow, exciting news. This is a huge leap forward. A great success rate too. Thanks for sharing this good news and good to see you here again!
Thank you..i hope you are well.
Thanks for such good info
Great doc
Love all the advice from this adorable doc ♡
Gud to see u back
Great information thank you
I have been told I need a pacemaker asap. I'm trying to get one of these.
Very helpful.
Had pacemaker for years. Just got new bullet. GREAT I SAY! I'm 77
Glad to see you back, was worried you were ill.
Hello Doc, been watching your videos for years now. Found Heart Failure and AFIB at age 47( 2017) RF was around 22%, my doc gave Beta blocks/beat enhancers and blood thiners. Was told to walk, so my wife and I walked several miles, several times a week. Got the RF to 52% Had both Cardioversion(1st lasted about 6 months next one I think 2 months) Cryoblastion twice. For the last 6 months EKGs have seen no AFIB, so Dr. had me wear a heart monitor for 2 weeks. Turns out my lower chamber are stopping from time to time, hated the idea of a pacemaker, Doc said the one they install in the heart would work for me. Looks like I am riding the technology wave 9/24/23 0950 getting read to go to church, thanks everone.
Great to see you back! Where you've been for all these days?
I believe he spent some time in Nairobi, Kenya, with his father who was not well and passed away. I don't remember when that was, but about a year ago seems right.
Hi Dr. Sanjay,
Thank you for your video, very informative. I love your channel.
I have AV Block 2.1 and had to have a pacemaker installed Sep 2020.
I am 57 years old and still very active [ I do kayaking etc ] so I looked into having a Micra lead-less pacemaker installed and my electrophysiologist [ in Dublin Ireland ] was happy to do so, however he felt it was best to use the older twin lead device [ manufactured by Medtronic as well ].
Reasons -
1. The Micra lead less device works well however it will only pace the heart efficiently up to 110 beats per minute.
2. Once the Micra lead less pace maker has been installed after x2 months it is extremely difficult to remove due to tissue from the heart growing around the device, at the attachment points.
As a result, when the battery expires it leaves you with having to install a second one in the heart [ this uses more volume in the chamber ].
3. Studies show that pacing from one chamber only when you have AV Block 2.1 can cause more rapid heart deterioration.
Note -
In Jan 2020 they updated the software in the Micra device so it now has the ability to pace dual chambers [ very clever, I believe it uses sound vibration to synchronise pacing ].
I went for the traditional Medtronic duel pacemaker in the end, and it has worked out fine so far [ 10 months later ].
Hope this info helps other people.
❤️😀
I am a new subscriber to your channel and binge watching your videos! I have recent anxiety and have been to 4 different E.R.'s with all kinds of blood tests, CT scans and x-ray. However, none of that has made me feel as calm and confident in my health than you. Thank you so much for your expertise and time!
Hello Dr. Gupta, this is very excellent information. Thank you for sharing. 😊
Thank you so much for giving that overview of leafless pacemakers. I have a dual lead pacemaker and I’ve always wondered if the leafless pacemaker would work for me. Since I need 2 leads for pacing, it looks as if the leafless pacemaker would not work for me.
I’m new to having my pacemaker about 5 months now. The complication that scares me is regurgitation at the tricuspid valve. I’ll be talking to my cardiologist about this at my next appointment in October.
Thanks again doctor for helping me to understand leafless pacemakers.
Nice to see you with the latest Infos. I watch regularly your videos but most of these are 4 or 5 years old. I was wondering why there is no fresh updates. Thanks for coming up with the latest. Keep it up bro. Your narration is like a poetry. We need you because most of the doctors take their patient for a ride. Be blessed. Any latest update about POTS?
Glad to see you back but I hope you’re ok ,you look tired
Great... Thank you
Thank you
We have an Angio dept at Darlington Memorial.
My moms cardiologist only out in one lead - when he said he was going to put in two. He put it in the top part - when she needed it in the bottom part. She had multiple blood clots in her left arm the day after surgery.
She had the battery replaced last October.
She is 85 and in heart failure and her doctor wants to put in new leads. She had a really good PA who got her out of heart failure for 3 years. But she is back in it again since replacing her battery.
Would this be something that would help her?
Nice video Doc. Could you make a video about ectopic atrial tacycardia?
Having once worked for a pacemaker manufacturer I know that the body encapsulates the leads making them most difficult to remove when a new pacemaker is implanted.along with new leads. It is the old leads which were left in place that can cause a constriction, that eventually lead to death of the patient.
Goodness, that's scared me! I have a pacemaker implanted nearly 2 years now. Hope I don't need it replaced anytime soon.
From the video I take it that the pacemaker with leads leaves the leads in place when a new "generator" is required. The spent main unit is exposed with an incision and the leads are disconnected from it, leaving the leads and the unit in place. The new main unit gets connected outside the body to the original leads and tested for operational adequacy. Then the original main unit is removed and the new unit implanted.
Hi Dr. Gupta. Thanks for revealing the existence of this " miracle" device.
Regarding infections , do risks of infections exist for as long as I have a pacemaker or just at the time of implantation ?
Like your videos , by the way.
Many thanks.
That's my question as well. I think it's an ongoing risk.
Hi enjoy your channel - keep it going! Question - my sister 71 now, and possibly I (66) have "hot spots" in the surface of her heart. Something weird about them, she had them hit with a laser I think - curious what you know about those. Me I had a 90% blockage that was rectified with a stent 3 yrs ago. So far so good - I went shopping 3 hrs after that procedure and felt like I was 40 again. Have had an echo cardiogram for the heart AND my carotids as well as ophthalmology, and endocrinologist for blood panels to regain my Medical for flying airplanes (used to be commercial bush pilot). I am also on TRT. results = all good green light to return to flying.
You’re not clear about the condition that requires 2 chambers (old pacemaker), rather than one. I have a-fib that comes and goes and wonder if I’ll need one of these someday.
Pray all feel better, thanks for info.
Dr. . Gupta, I live in the US. Do you do telephone consultations outside UK?
Thank you for your very helpful videos.
Yes I do..i can be contacted via yorkcardiology@gmail.com
do they have the same thing with defibulators ??
Please make a video on Jugular vein distension (JVP) does it related to heart failure. From last week I can see a slightly visible vein on my neck right side does it related to heart failure or because I am thin and tall.
??
Thank you for your informative content. I have 2 questions.
If the device has to be removed what kind of damage will the tines do to the heart? If removed Will the tines leave a space that could potentially fill with fluid or blood?
Did you ever get to know the answer to your question? I was interested as I have a pacemaker implant.
@@gwenfancello5384 no unfortunately I never got a response. I have a pacemaker with leads. I am curious about the leafless one though. I will probably talk to my electrophysiologist about one if I ever have to have this one replaced. Best wishes to you!
@@amym7825 And all the very best to you 🙏
@@gwenfancello5384 no answer-beat wishes to you
I’m imagining a knife attack and removal of it will lead to gushing out of blood if not squirting 😢
Do pacemakers help with I Atrial flutter ? If not.would this work if attached to an atrial chamber?
What kind of magical battery will be a full time lifesaver for fifteen years? Lithium primary cells are good for about ten years, but only if you're not using them. Modern rechargeables are swollen toxic trash after about five years.
If not rechargeable then lithium thionyl is a good bet. They're also used in high tech equipment which doesn't have possibility to be recharged or having battery changed yet the equipment works for 20+ years. Lithium thionyl has even more energy and longer shelf life than regular high grade lithium cells (Like energizer L91, CR123 etc.).
(And can you overlook the calibration certification replacing the cell(s) and it'll work for another 20+ years - personally I've replaced a few cells in laboratory clock/stop watches on behalf of a family member and saved their employer for huge amount on new stopwatches (no issues with calibration for their use))
I wanted to ask you about the Xio Patch. How does that work? I'm wearing one right now, but I don't understand how two leads replaces 12...
The idea of it moving along an artery to somewhere it shouldn't be is pretty scary.
We missed you Sanjay, when I fisrt saw the title I was very enthusiastic but when you explained how it works I was bit of disappointed, as the way through the blood vessels is not very appealing to me, reminds me of my dad who needed a stent for an aorta aneurysm but his iliac arteries were making a lot of turns and they might be not so flexible because of his age , so there might be a danger of repture of the vessel, so this danger may stand in this ocassion too. I tought that technology had invented something that could control the pace from outside through a bluetooth or something like that, I am sorry to day that medicine has poor outcomes in common cardiac diseases and this also leads me to wonder if they fail on purpose, anyway, I was really glad to see your smiling face again.!!
On purpose? I'm fairly cynical about a lot of things these days, but there's too much regulation to go through to design something to fail in medicine ... at least so far.
What type of exam's n tests are done to determine if a person need a pacemaker?
I would like to know too.
My Dr.wants to but a dual peacemaker in me one wire on top of heart,and 2 wires on the bottom. I like the one you talk about am in Mo. Do they do the pacemaker you talk about here in Mo.
Dr you are looking much better.. How is your father.
Biological Pacemaker TBX-18, please do talk about that doctor how far are we into human trails if any???... Thank you doctor
After one year and 4months of unexplained palpitations, which resting ecg keep showing normal, echo last year shows remodeling of left ventricle with no valvular abnormalities.
I did holter last 4weeks.
My holter result shows 326 episodes of atrial fibrillation, 21 episodes of bradycardia, 1 episode of tachycardia and 1 episode of wenckebach block. I haven't faint before. Please do I need pacemaker or I will be fine? My cardiologist havnt said anything yet. Am just 29
Is this good for Bradycardia??
This hit me - no rhyme or reason!! I am angry - I was in great shape and suddenly - I am in pacemakerville!!!
My holter result shows 326 episodes of atrial fibrillation, 21 episodes of bradycardia, 1 episode of tachycardia and 1 episode of wenckebach block. I haven't faint before. Please do I need pacemaker or I will be fine? My cardiologist havnt said anything yet. Am just 29
@@ifeanyijoshua6773 I feel your pain - hang in there!
Potassium capsules and Hawthorne Berry capsules - helped a little.
@@QuantumOfSolace1 thanks much I appreciate. Am trying my best to see if this issue cn stop....It havnt been easy. I don't smoke, nor drink. Can it be because of my everyday playing football? I hope I get healed
Sir I have ectopic heart beats,and palpitations sometime,I'm having a surgery not related to heart will it be safe?
Do you have any videos on hypertrophic cardiomyopathy? Thank you 🙏🏻
@chintu my niece does
Go to his channel to see any and all of his videos.
@@virginiamoss7045 thank you !
Hi!! How do you know if you will need one in the future. My heart rate is low and seems to be getting lower but with no symptoms. How do you know if something is going wrong with your heart?
My son is 12 years old 5 months ago first time put pacemaker but he was infected that’s why now doctor remove pacemaker now doctor said he need three chambers pacemaker need so leadless pacemaker helpful for him or not ? Plz reply me about it .
so since i have one can i get this one - i have Metronic was put in 6/4/20
How long can a lead less pace maker last and can they be removed?
SIR, WHAT IS LEFT ATRIAL ENLARGEMENT, MY ECG SHOWS LEFT ATRIAL ENLARGEMENT
Can I come and see you and how do I make an appointment and what kind of Insurance u take I like to discuss about my heart condition
Would they be suitable for wheelchair users
Dr i have high heart beat problem
Does 10% blockage of carotid artery require medication? Can't tolerate aspirin and now doc wants me to try plavix.
Hi doc great to see u again..want to know about my skip beats can u plz guide mw
My resting HR 110 my throid levels r normal, not anemic..even on metoprolol 25 mg HR does nt come down what to do
@chintu has increased my dosage of metoprolol.. As of now trying to figure out
What about for those with unknown heart conditions that have yet to have a cardiac arrest…I know proper ECK & ECG along with cat scan of heart is best…maybe wearing a CPR vest around that an auto-detect a cardiac arrest and gives you the electro CPR shock to restore the heart rhythm to restore consciousness and follow-up with proper medical heart work-up at a hospital if no one that knows CPR and AED defib device is around or near you to resuscitate you …that way you won’t die.
Follow Up Video from manufacturer (Medtronic): ruclips.net/video/HRyvxx0cIdE/видео.html
(NOTE: Almost all of the second half of the video is note cards that can be paused and read at your leisure, giving further safety details and info!)
How do you know all those things? My cardiologist has no idea what you are talking about....
Hi Doc. Did you take the jab?
The science is amazing, but there are serious cons for patients who are terminal. My mother had a medtronic pacemaker after her heart attack due to low heart rate. Soon after we found she had aggressive breast cancer. While on hospice, it was time to turn it off as most hospice's do to patients toward the end, so she could go naturally, but they surprisingly refused. We had the medical team and hospice team talk to them and advocate for us quite a bit, and they said no. People need to know this as it's a serious issue and in my opinion cruel and unethical.
This interest me. Very elderly Grandfather at his end in the hospital....I was told his pace maker held up his end...I could not find out details. I do not want to be bionic.
@@spocksdaughter9641 Yes understood. The traditional pacemakers under the skin get turned off easily waving a large magnet over the device. A nurse tried that method, but it did not wrk. We learned w/ these newer style devices implanted in heart you need a special technician to come disconnect it, but again they refused.
@@mommasoto wow thx, I just surfed the new styles of leadless pacemakers. Some they can't take out of where they put them deep in the heart or they may tear the heart.
AND development on as far as I can tell, literally genetic changes not sure how maybe also tissue implants but a long way off. I appreciated your educating me. Imo science is a two edge sword.