New pacemaker leading the way for heart patients
By Carla Slavey
Cardiologist Michael McKinney likens the heart to a house . There are three components : The structure , the electricity and the plumbing . All three are separate , but work together to make the home run smoothly .
For some people , one or more of those components has problems . And it ' s up to doctors like McKinney to diagnose the problem and shore up that aspect of the house .
Just as there have been new technologies for delivering electricity to one ' s home , there is a new tool in the shed to help fix the electrical signals to one ' s heart : a pacemaker that doesn ' t require wires to deliver the signal from the device to the heart . Rather , as Dr . McKinney explained , the device sits directly in the heart .
It ' s called a leadless pacemaker – that ' s " lead " pronounced like " leading a horse to water ," not as in the mineral or what some call the graphite in pencils .
For Lake Cumberland Regional Hospital and Lake Cumberland Cardiology Associates , the first leadless pacemaker was implanted into a patient a few months ago , Dr . McKinney said , while the first dual-chamber leadless pacemaker was placed about a month ago .
" Apparently that ' s a rare event for a rural hospital to do ," McKinney said .
The leadless pacemaker works by going through a vein to place a onepiece device directly into the heart .
" A regular pacemaker is a battery and a generator that fits in under the skin , under the collarbone ," McKinney said . " We have to run wires to the heart for that to do its job . The leadless pacemakers – they look like . 22 bullets
– they go in just straight into the heart , and everything that a pacemaker does is built into that little tube . It decreases the complication rate , decreases the infection rate , and it prevents us from using veins in people who need those veins , so it prevents us from closing down an access site for chemotherapy or dialysis . And the battery actually lasts twice as long ."
The new style of pacemaker won ' t replace the traditional one completely , McKinney said .
" The others are tried and true ," he said . " They ' ve got 50 years of data on them , so that ' s still going to be the most common pacemaker . This ( new one ) will be 10 % ( of cases ). It may increase to 20 %, but it won ' t be the only one ."
So what kind of patients are likely to benefit the most from the new style of pacemaker ?
For starters , it helps those who only need a one-lead pacemaker to begin with , he said .
Patients may need one or two leads – the wires that go from the traditional pacemaker to the heart . However , for the traditional pacemakers , surgeons usually put both leads in , " because you never know when you ' re going to need the other ," he said .
" If they only need one , then this ( leadless pacemaker ) is a better option because the battery lasts longer ," McKinney said .
A second group that would benefit from the new technology is younger patients . Some children are born with heart issues , he explained , so need pacemakers from birth .
Children can easily outgrow the leads they are given , requiring the leads to be swapped out , he said .
Another group that can benefit are patients who require dialysis or chemotherapy , because the traditional pacemaker requires the use of a vein to run the wires – a vein that could also be used for those other treatments . Having a traditional pacemaker takes away one of the options for those patients , he said .
A fourth group of patients to benefit from the leadless design are those who are immunocompromised , such as those undergoing chemotherapy or who have a disease , such as AIDS , that affects the immune system .
" Pacemakers tend to get infected if bacteria get into the system ," McKinney said . " These don ' t because there ' s no wires associated with them , and the bacteria doesn ' t attach to them ."
Whichever type of pacemaker a patient receives , McKinney stressed the need to follow up with their cardiologist . A pacemaker is not a " set it and forget it " kind of device .
" Every six months , a patient will come in and have their device interrogated , so that we can decrease the amount of energy that it takes to pace the heart , so the battery will last and we ' ll get the most out of the battery ," he said . " Or , we can determine if it ' s failing in some way , so we can start monitoring it a little closer ."
A traditional pacemaker usually lasts eight to 10 years , he said , while parts of the new style can last up to 20 years .
All of this is to correct issues with the electrical part of the heart only . So what about the other two aspects – the plumbing and the structure ?
Most cardiac patients will be told to live a " heart healthy " lifestyle , and that may help for issues with those two parts of cardiovascular health .
February 2025 SEKY - Southeast Kentucky Life • 7