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A new ray of hope in Pacing- Introducing “Leadless Pacemaker”

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Cardiac Care

A new ray of hope in Pacing- Introducing “Leadless Pacemaker”

Dr. Vanita Arora
Cardiac Sciences, Cardiology
Cardiac Sciences, Cardiology
Associate Director & Incharge – Cardiac Electrophysiology Lab & Arrhythmia Services, Senior Consultant-Cardiac Electrophysiologist & Interventional Cardiologist

You must know that pacemakers are surgically implanted devices that generate electrical impulses to treat irregular or stalled heart beats. More than 1 million people across the world are implanted with pacemakers each year. We introduce a new pacemaker "Micra"- an inch-long device that does not require the use of wired leads in order to provide an electrical connection between the pulse-generating device and heart. 

Traditional Pacemaker v/s Micra

In a conventional single chamber pacemaker, the leads that run from the pacemaker are implanted under the skin near the collarbone, through a vein directly connecting into heart’s right lower chamber. These leads are responsible for delivering electrical pulses from the generator to the right lower chamber in order to coordinate the timing of chamber’s contradictions. These leads can only be removed surgically resulting in a high risk surgery.                                                                                                                                                                                                               . 

 

On the other hand, Micra eliminates the use of these leads, as they can malfunction or cause problems when infections develop in surrounding tissues, requiring a surgical procedure to replace the device. As it is a single chamber pacemaker device, it prevents problems that are associated with wired leads. It is especially designed to treat patients with heart arrhythmia or those who have other risky arrhythmias such as bradycardia-tachycardia syndrome.

Micra is not meant for patients who already have implanted devices, are morbidly obese, or have an intolerance to materials in the device or blood thinning disease. This is also true for patients whose veins cannot accommodate the 7.8mm introducer sheath or pacemaker implant.                                                                                                                                                  

Advantages of Implanting MICRA

You must be aware that most pacemakers are implanted in the patient’s chest with leads running to the heart, whereas MICRA is implanted directly in the patient’s heart. Below mentioned are few benefits of implanting MICRA:

Less Invasive: It is implanted directly in the heart via a vein in the leg, thus no chest incision, scar or bump unlike the conventional pacemakers.
Self Contained: The device is completely self-contained within the heart, therefore eliminating potential medical complications that may arise from a chest incision or form wires attached from a traditional pacemaker in the heart.
Small: The device is about the size of a large vitamin capsule ie 93% smaller than conventional pacemakers.   

Note:  It has less complications as well as post implant activity restrictions. It is time-tested and contains certain valuable features - It allows the patients to safely undergo magnetic resonance imaging (MRI), and adjusts your heart rate automatically by sensing changes in your body related to your activity level. MICRA’s estimated battery longevity is 12 years.

Few FAQs Answered

- Is Micra the right pacemaker for all patients?

  No. Micra is primarily intended for patients who require a single chamber pacemaker (also known as ventricular pacemaker or VVIR).

- How is Micra placed in my heart?

It is inserted like a “straw-like” catheter in a vein in your upper thigh and then the catheter is used to move Micra in the right lower chamber of your heart. Thereafter, catheter is removed. It is almost like doing an angioplasty and leaving a stent in the blocked artery, and then removing the catheter and wire from the leg.

- Are MRI scans okay with Micra?

Yes, as Micra is designed, tested and approved to be safely used with 1.5 & 3 Tesla MRI scanners. MRI scans are possible as long as your eligibility criteria are met.

- Should I keep the items containing magnets away from leadless pacemaker?

It is recommended that the items containing magnets should be kept 6 inches away from an implanted pacemaker. This includes mobile phones, stereo speakers and handheld massagers. Also, it is important to refrain from putting a mobile phone in your short pocket or using magnetic mattress pads or pillows.  

- Is it safe to go through an airport metal detector?

Yes, you can safely go through airport security with this device.

- Are household appliances safe to use?

Yes, those household appliances, which are properly maintained and in good working condition are safe. This includes microwave ovens, major appliances, electric blankets, and heating pads.

- Can I exercise or resume my regular activities? 

Yes, you should be able to return to your usual activities, as long you do not exceed your fitness level.

- Does Micra lasts forever?

No, Micra features a battery and its life depends on your heart condition. The estimated average longevity is 12 years. Individual patient experience may vary.

- What happens when the Micra battery runs low?

Micra is designed to provide options when a new device is needed. It may be turned off and a new Micra or a traditional system may be implanted. It also offers a retrieval feature to enable the options, when required.

- How often will I need to visit the doctor after Micra is implanted?

It entirely depends on your doctor when he wants you visit. Typically, the first follow up appointment is one month after the implant, with additional follow ups every 6 months.