Pacemaker playing up? Time to join the wireless revolution
NEARLY a million Britons have heart failure — meaning the heart is not functioning as well as it could — and some will need a pacemaker. Gordon Redhead, 78, a retired estimator from Co. Durham, had a new wireless device fitted, as he tells CAROL DAVIS.
THE PATIENT
STrIdING through lovely countryside near our village two years ago, I started panting and could feel my heart pounding really fast. Something clearly wasn’t right. I’ve always loved hillwalking and play golf several times a week and never had problems before.
I went to the GP the next day and had an ecg, which measures your heart’s electrical activity. It showed it was beating erratically and up to 157 beats a minute. Normally, it should be 60 to 80 beats. I was stunned because I felt fine. My GP referred me to James Cook hospital, where they told me I had atrial fibrillation, an irregular heartbeat that’s also often very fast. The doctors didn’t know what caused it, but prescribed medication.
The pills didn’t help, though. I was always breathless and was also getting dizzy spells, so I decided to give up driving. My wife Christine and I couldn’t go out much, which made me fed up.
Then last April, about a year after the problems started, I woke up in the night gasping for breath, with my heart beating really fast. Christine had to rush me to hospital.
A consultant told me I had heart failure — where you don’t pump enough blood round the body — and my heart was ‘wrecked’, possibly connected to the atrial fibrillation. Frankly, this was terrifying.
I was referred to a specialist, dr Andrew Turley, who I saw four months later. he recommended I have a biventricular pacemaker and defibrillator fitted, which would shock my heart back to normal rhythm if it started beating irregularly, but also keep it beating.
It involved having an implant that would act as a defibrillator and pacemaker on the outside of my right ventricle (the bottom right chamber of the heart) and another implant that would act as a pacemaker on the left ventricle.
These would be connected by wires that would be threaded through my blood vessels to a generator implanted just below my collarbone.
I went in for this surgery in October 2015, but dr Turley stopped after he had fitted the implant on to my right ventricle because the wires couldn’t reach the left.
he told me I had a rare condition where the way my blood vessels were arranged meant he couldn’t feed wires through to connect the pacemaker on my left ventricle — so he couldn’t proceed.
At my next appointment, he told me about a new wireless pacemaker that could help.
Unlike standard pacemakers, which are wired on the outside of the ventricle, the new wireless technology would mean the pacemaker implant would go inside the ventricle, while the generator would be implanted between my ribs.
The generator would receive electrical signals from the defibrillator on my right ventricle and send ultrasound signals to the implant in my left, to make the heart beat as it should.
It was so new that I would be one of the first in the world to have it — but I didn’t care. I couldn’t wait to get active again.
So last month, I had an operation under general anaesthetic to implant the generator, and the next day, another op to put the pacemaker — which is the size of a grain of rice — in my left ventricle.
It was inserted via an artery in my right groin up to the heart. For this operation, I had just local anaesthetic and sedation, and could chat to the doctors.
Over the next few days, my energy returned and the colour came back to my face. Now I’m full of energy and am walking around the village and driving again. I feel so much better.
THE CONSULTANT
Andrew Turley is a consultant cardiologist at South Tees Hospitals NHS Foundation Trust. Around 900,000 Britons have heart failure, where the heart is not pumping blood around the body efficiently. It causes symptoms, including fatigue and breathlessness.
There are many causes. The most common is damage to the heart as the result of a heart attack. Conditions such as atrial fibrillation can be a symptom. If left untreated, heart failure can be fatal.
There are a number of medications that can help, including ACE inhibitors to improve how efficiently the heart pumps and beta blockers to protect against dangerous heart rhythms.
If these don’t work, doctors implant a defibrillator on the right ventricle to protect against sudden death if the heart goes into an abnormal rhythm, and a pacemaker to help the heart beat regularly and more efficiently. We generally use a biventricular pacemaker with wires that feed on to the right ventricle (which pumps deoxygenated blood to the lungs) and the left ventricle (which pumps oxygenated blood around the body).
But 30 per cent of patients don’t respond to these pacemakers, sometimes because the wires can’t reach the left ventricle or because they become dislodged.
Gordon’s problem was different and pretty rare: the blood vessel we usually feed the lead through wasn’t in the right position.
A new option is a pacemaker known as WiSe technology, first fitted in a patient in the U.S. in 2011. It is completely wireless and receives ultrasound impulses from a generator implanted between the ribs.
As well as being free of wires and the complications that come with them, it means we can implant the pacemaker into the inner layer of tissue lining the left ventricle, where it can work most efficiently, instead of putting it on the outside of the ventricle.
The pacemaker is less than 1cm long, with a grappling hook at the end to fix firmly into the heart muscle.
during clinical trials, patients whose conventional pacemaker treatment had failed had an 81per cent improvement in their condition with the WiSe technology, which is incredibly exciting.
At James Cook University hospital, we are very proud to be the first in the world to use this outside a research study.
First, the patient has surgery to implant the matchbox-sized generator between their ribs through two incisions roughly 5cm wide. It takes around an hour under general anaesthetic.
Then patients will have the twohour procedure to feed the pacemaker into their left ventricle.
This could be straight after or the next day, depending on the patient’s condition.
For most patients it is more logical to do it in two sessions.
To fit the wireless pacemaker, we sedate the patient and use a local anaesthetic to block pain in the incision site.
We make a 4mm nick in the skin in the groin, and get into the femoral artery.
We Feed a catheter with a wire inside it through to the left ventricle — we can see the wire using X-ray and ultrasound throughout the procedure, and use this as a guide to show where the implant needs to go.
We feed a larger catheter containing the pacemaker implant through, using the wire as a guide.
Then we test the implant works and the heart muscle is healthy by creating an electrical circuit using electrodes on to the groin.
If all is fine, we press the implant into the ventricle wall so the grappling hook holds it firmly in place. Then we withdraw the catheter and seal the nick in the artery and skin with stitches.
Patients can go home in a day or two — we monitor how the device is working using a special program on the computer that checks its signals.
Patients will be given anticlotting medication to take for three months afterwards.
I’ve done three such operations and think that one day it could be an option for all heart failure patients who need a pacemaker.
THE procedure costs the NHS around £16,000. It is not yet available privately.