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October, 2015 :15
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Know the MICRA story

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Know the MICRA story

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

Mr. Goel’s condition was deteriorating every day. His kidneys had failed due to which he was on dialysis 3 times a week. Moreover, a shunt was made on the left side of neck to allow hemodialysis. His urine output was very low throughout the day and his immunity was also decreasing. Around 6 months, a pacemaker was implanted in a peripheral hospital on the right side of his chest. His pocket site was appearing swollen since last 5-6 days and the skin was gaping with some discharge. It seemed he had developed some infection in the pacemaker pocket.

At Max, he was put on a temporary pacemaker while his permanent pacemaker was explanted along with leads from his chest. His infection was taken care with daily dressing and intravenous injection of antibiotics.

But a bigger challenge lay ahead. Both sites from which the pacemaker could have been implanted were choked. Right side vein had infection and left side vein had a fistula for hemodialysis. Thus, the only option left was to do to open heart surgery for implanting the leads on the heart surface and placing the pacemaker in the abdomen. The surgery seemed inevitable despite Mr. Goel’s reluctance and denial. His heart was totally dependent on temporary pacemaker and there was no access to subcutaneous pacemaker. Only if there was a way to be less invasive or we could have done away with leads and pacemakers, things would have been simple for patients like Mr. Goel and we would have been able to avoid the high risk of surgery in his critical and frail condition.

The incidence of infection, pocket hematomas, leads complications has increased over a period of time. Though the field of Cardiology has made several advancements in the last 2 decades in the treatment of coronary artery disease with bypass surgery (open heart surgery), for blockages in heart arteries being replaced by angioplasty and percunatenous placement of stents, despite that the procedure of pacemaker however has not changed from last 4 decades. 

However, a ray of hope has now come as latest technological innovation in pacemaker procedure in form of “Leadless Pacemakers” called MICRA. It is like a capsule, which is 1.5 & 3 Tesla MRI Compatible and battery longevity of more than 11 years.  The technique of pacemaker implantation has undergone a drastic transformation in order to do this procedure safely with good outcome in geriatric as well as high risk group of patients.

Benefits of MICRA

  • It has become as simple as performing an Angioplasty or RF Ablation with mobility of patient permitted in 3-4 hours and go home within 24 hours.
  • The risk of infection has been minimized to nil with the procedure becoming percutaneous. Hence pacemaker pocket infection, hematomas, lead complications, lead fracture, pneumothorax, subclavian thrombosis are not a matter of concern.
  • Better cosmetics are achieved with scar less procedure as it is done through femoral venous route.
  • It is a relief especially for elderly patients, with bad lungs, on hemodialysis with shunts, oncology patients undergoing radiotherapy, patients with other comorbidities, and patients with indication of single chamber pacemaker implantation.
  • Self-contained: Micra is completely self-contained within the heart. It eliminates potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart. 
  • Less invasive: Micra is placed in the heart via a vein in the leg, thus no chest incision, scar, or bump that results from conventional pacemakers.