Tiny pacemaker brings back elderly patient’s smile


Graham Anthony Troy and his wife Yvonne both have pacemakers – but only one of them has the chest scar to prove it.

That's because Graham, an 84-year-old retired boat builder, is the first person in Sydney's South to have a revolutionary tiny leadless device implanted in his heart.

“I’ve had issues with my heart since March 2017, with daily chest pain. My wife said she hadn’t seen me smile in a long time as a result. I was apprehensive about the procedure but only a day later and I’m on my feet and ready to go home,” Mr Troy said of his operation at St George Private Hospital.

Yvonne, his wife of 53 years, had her pacemaker inserted 12 months previously through the traditional open technique.

“I’m very relieved he followed in my footsteps to get the issue addressed, although he doesn’t have the matching scar to prove it,” she said.

The leadless device – a Medtronic Micra Transcatheter Pacing System – weighs less than a 10-cent coin and is the size of a large vitamin pill, about 20 percent as big as a traditional pacemaker with battery attached to wires.

The procedure involves passing a tube up the femoral vein in the leg into the heart's right ventricle, then delivering the pacemaker through it and implanting it in the bottom-right area where a traditional wire would be placed. Hooks on the device keep it in place by embedding into the heart muscle tissue.

After testing that the pacemaker is sending the right electrical impulses to keep the heart beating regularly, the tube is removed and the patient can usually go home the next day.

Dr Sean Gomes and Dr Maurits Binnekamp implanted the Medtronic Micra pacemaker at St George.

Dr Sean Gomes, who performed Mr Troy's implant along with fellow St George cardiologist Dr Maurits Binnekamp, said the Medtronic Micra is the first major advancement in pacemakers since he started as a proceduralist almost a decade ago.

Having no lead, the device avoids the "weak link" of the conventional system -- where the wires often need to be removed or replaced.

“For patients this minimally-invasive procedure means an improved cosmetic result as there is no scar or device visible under the skin. There is also potentially reduced risk of long-term device infection,” Dr Gomes said.

Unlike traditional pacemakers, the battery of the Medtronic leadless device is not replaced at the end of its lifespan – which is similar to the conventional one's 8-10 years.

“At the end of that period, if this technology is used again, a new leadless pacemaker will need to be inserted. We would expect in 8-10 years this type of battery will be smaller but we can't guarantee that,” Dr Gomes said in an instructional video explaining the procedure to potential patients.

He added that it has been safely tested, with thousands of patients in Australia having had the leadless pacemaker routinely implanted in the past two years.

However, he said the Medtronic Micra is not suitable for everyone who needs a pacemaker -- it cannot replace a dual or triple-chambered device.

“Essentially any patient who is a candidate for a single-chamber pacemaker is a candidate for a leadless device. Patients who have a high risk of pacemaker infection would be considered especially good candidates,” Dr Gomes said.



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