SHARES
Only a handful of doctors in Singapore are trained to implant the world’s smallest pacemaker, the Medtronic Micra® Transcatheter Pacing System (TPS), and the Cardiovascular Suite (CVS) team at Farrer Park Hospital (FPH) has successfully done so.
Dr Ruth Kam Ming Li
Led by Cardiologist Dr Ruth Kam, the CVS team implanted the small and leadless pacemaker into a 76-year-old patient through a minimally-invasive procedure. Implanting such an advanced device is unlike the usual pacemaker implantation. “In my more than 20 years of implanting pacemakers, this is the first time that I have implanted a pacemaker without any wires. The whole system (battery, circuitry, and wire) has been shrunk down to a capsule-sized device that is one-tenth of the volume. The procedure is short and the patient has no visible reminders of the pacemaker on the outside,” says Dr Kam.
The CVS at FPH is an integrated facility encompassing three fully functioning operating theatres specific to cardiovascular procedures. The CVS team, which includes medical technologists, radiographers, and nurses, is highly trained in their respective roles and their expertise ensured seamless teamwork during the operation. The successful implantation of the world’s smallest pacemaker is another milestone achievement of FPH.
So, what is a pacemaker? Who can wear them and what problem does it solve? We know there are lots of questions in your mind, and we will try to answer them here:
What are pacemakers?
Pacemakers are tiny electronic devices which assist in maintaining the proper rhythm of the human heart. The human heart beats at an average of 72 beats per minute. When the heart beats too slow or the beating of the heart becomes improper due to fault with electrical conduction of the heart, it’s called Arrhythmia (abnormal heart rhythm). Pacemakers are then used to correct this.
How does the human heart function?
The human heart consists of four chambers. The upper chambers are called atriums and the lower chambers are called ventricles. Lungs filter out the carbon-di-oxide from the blood and replace it with oxygen. This blood then enters the left upper chamber. On contraction, it then enters the left lower chamber. The lower chambers contract and the pure blood is pumped through the aorta throughout the body. Similarly, the right side collects impure blood from the entire body and sends the blood to the lungs through the pulmonary vein for it to be oxygenated.
How does the human heart, beat?
The human heartbeat can be explained by the ECG graph very easily. A tiny bunch of muscles called the SA node located in the right atrium contract and send electrical impulses to the left atrium. The top chambers contract before the impulses reach the bottom chambers. When the impulses reach the bottom chambers they contract forcing the blood up the blood vessels. In the ECG The P region represents the upper chamber contraction. The QRS represents the lower chamber contraction and the T represents the relaxation of the lower chambers.
Who requires a pacemaker?
In a heartbeat, timing is everything. When the heart’s electrical system becomes faulty, the impulses may not originate properly (sick sinus), upper chambers may not contract properly, lower chambers may not contract properly or the synchronisation may not be there. In either or all of these cases, a pacemaker becomes necessary to help the heart function properly.
What are the types of pacemakers?
Single chamber pacemaker is the one which controls either the upper chambers called the auricles or the lower chambers named ventricles.
Dual-chamber pacemaker is the one where leads are placed into both upper and lower chambers.
Rate-responsive pacemaker is the modern advancement which senses the physical activity changes in the body and adjusts the rate of pacing accordingly.
How is the pacemaker placed in the body?
The surgery is a small one and is generally performed under 90 min. A small incision is made below the left collarbone and the pacemaker is placed inside. With the help of a dye, the surgeon sees the contrast image on a fluoroscope. The leads are initially placed into a large vein and then in the appropriate place in the heart.
How frequent will the follow-ups be?
The follow-up frequency will be between 3-6 months depending on many factors. The batteries of the pacemaker will last 5-8 years or more. After that, a surgery will be required to change it.
What are the dos and don’ts?
Pacemaker patients can have a normal life thanks to the advancements in science. Do regular check-ups as advised by your doctor and follow his/her advice strictly.
Don’t keep your phone or microwave too close to your pacemaker as there may be interference. You cannot (as of today) take an MRI scan with a pacemaker on.
What is the future for pacemakers?
The current advancement in the rate-responsive pacemakers which alter the rate depending on the need. Scientists are developing battery-less pacemakers which may derive energy from the vibration each heartbeat produces.
The leadless pacemaker is a giant leap forward in the pacemaker history. This breakthrough technology is still in nascent stages elsewhere in the world. The Farrer Park Hospital (FPH), Singapore’s leading healthcare provider, has since successfully implanted the world’s smallest pacemaker, the Medtronic Micra® Transcatheter Pacing System (TPS), into a 76-year-old male Chinese patient. This nanotechnology capsule was placed directly on the heart wall through the vein (femoral) in the leg in a minimally-invasive procedure.
To make an appointment with Dr Ruth Kam, visit GetDoc!
by Hridya
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya.
