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Tiny pacemaker, big advantages

A new, minimally invasive surgery option is now available in New Mexico for patients who need a pacemaker to regulate an abnormally slow heartbeat.

Doctors with Presbyterian Healthcare Services have begun using the Micra, dubbed the “world’s smallest pacemaker,” using a technique that delivers the device directly into the patient’s heart.

Each year, about 350,000 people in the U.S. receive a pacemaker to correct an irregular heart rhythm caused by the electrical impulses within the heart firing erratically. Patients may be as young as infants, if they are born with a heart problem. More often, older people need a pacemaker because of heart disease.

Pacemakers have been around for several decades; first as devices worn externally, then implanted in the chest with electrical wires leading from the heart to a generator.

Dr. Lawrence Nair, director of electrophysiology at Presbyterian Heart and Vascular Care, reports positive results with 10 patients who have received Micra pacemakers. (Courtesy of Presbyterian Healthcare Services)

But the leads can cause problems, said Dr. Lawrence Nair, director of electrophysiology at Presbyterian Heart and Vascular Care.

They can fracture or become a source of infection that can even harm the inner lining of the heart. Removing problematic leads involves a complicated surgery, he said.

A big advantage of the Medtronic Micra Transcatheter Pacing System is that it contains all the electronics needed to control a patient’s heartbeat packed into a cylinder-shaped device about one-tenth the size of a traditional pacemaker. It was approved by the Food and Drug Administration in 2016.

“It’s quite a big difference,” Nair said.

The Micra is most suitable for patients who are getting a pacemaker for the first time. It is approved for those with symptomatic bradycardia – an abnormally slow heartbeat – who experience symptoms such as dizziness, shortness of breath, fatigue and fainting spells. It will regulate beating of a single heart chamber. Patients who need a device to control more than one chamber will still need a traditional type pacemaker, Nair said.

Surgery to implant the Micra involves a small incision in the groin area through which doctors insert a catheter and guide it to the heart. The Micra device is implanted directly into the tissue of the right ventricle.

For a traditional pacemaker, doctors make an incision under the collarbone, and patients have to keep an arm at their side and avoid any exertion for weeks. With the Micra, there is no arm restriction, no visible bulge from the pacemaker in the chest and no risk of infection from leads, Nair said.

He said Presbyterian doctors have performed the Micra pacemaker surgery on 10 patients since early March, and all are currently doing well.

Lovelace Health System and the Heart Hospital of New Mexico can also do the procedure but as of late May had not selected any patients, said spokeswoman Whitney Marquez.