Treating AFib with the World's Smallest Pacemaker: Tom’s Story

Tom Lacy | Doylestown Health

Doylestown resident Tom Lacy, 75, was enjoying a Maryland golf vacation when his slow heartbeat got in the way. The course was soggy, and a cart path-only restriction was in place, so he was walking from the path onto the fairway to take his shots.

"I was exhausted and short of breath, so I played only 13 or 14 holes in the last round," says Tom, who has atrial fibrillation (AFib), an irregular heart rate or rhythm that can cause poor blood flow.

"I've been seeing electrophysiologist John Harding, MD, (heart rhythm specialist) at Doylestown Health for 10 years for AFib," explains Tom, "And when I told him about my symptoms, he asked me to come to the hospital for tests."

Tom was diagnosed with bradycardia (a slow heart rate), which causes symptoms including fatigue, dizziness and in some cases passing out.

Tom's Story: Miniature Technology, Maximum Impact

Weighing Options

Dr. Harding and his colleague electrophysiologist Robert Sangrigoli, MD, visited Tom in the hospital to discuss his treatment.

"I was going to need a pacemaker," says Tom, "It was just a question of what kind. Regular pacemakers are bigger and they have wires, so you must limit activity. You can't lift your arm over your shoulder for about four weeks."

"When considering a medical device, we let patients know, there are options. The decision is individualized and tailored to each patient's needs," explains Dr. Harding.

Dr. Harding explained that the Medtronic Micra leadless pacemaker does everything a regular pacemaker does, but it's one tenth of the size. The entire device, a tiny capsule less than an inch long, is implanted directly into the heart wall without invasive surgery, so there is no scarring or evidence of the pacemaker outside the body.

Approved by the FDA in April 2016, the leadless design reduces infection risk and eliminates the problem of leads dislodging with arm movement, so patients can be active sooner.

"We are excited that Doylestown Health continues to offer groundbreaking technology designed to make patients' lives better," says Dr. Sangrigoli. "In the field of cardiac pacing, we can now offer something very small that we know can make a big impact."

Similar to a traditional pacemaker, the Micra's battery lasts about 12 years; however, the leadless pacemaker does not have to be replaced when the battery runs out.

"It is so small that replacement devices can be placed next to the original," says Dr. Sangrigoli.

Feeling Great

After weighing his options, Tom became Doylestown Health's first leadless pacemaker recipient in October 2017.

"The next day I was home, I could drive and do anything I wanted and my heartbeat was regular," remarks Tom, who is busy at work and looking forward to hitting the links this Spring.

About Traditional Pacemakers

Pacemakers are designed to treat bradycardia (slow heart rate). Traditional pacemakers are surgically implanted devices that generate electrical impulses to treat irregular heartbeats. About the size of a half dollar, the device is implanted in a pocket of tissue under the skin near the collarbone. The leads (wires) run from the pacemaker through a vein into the heart's right ventricle. These leads deliver electric pulses from the generator to the right ventricle to help maintain a normal heart rate.

The Pacemaker of the Future

The Medtronic Micra leadless device is intended for patients who need a single-chamber pacemaker, though Dr. Sangrigoli notes that this rapidly emerging technology, over the next few years, may completely replace traditional pacing systems, even when both the upper and lower chambers of the heart require pacing.

Seamless Care, Close to Home

Any adjustments and follow up care for Tom's pacemaker can be handled by experts at Doylestown Health Cardiology's Device Clinic, staffed by a nurse practitioner and full-service team in the same location where he sees Dr. Harding.

The leadless pacemaker offers full remote monitoring capability. A home monitor near the patient's bedside takes readings from the patient's heart device and simultaneously communicates the information to the doctor's office.

Doylestown Health AFib Center

Doylestown Health physicians have extensive experience treating irregular heartbeats. Doylestown Health's AFib Center offers a complete range of treatments for the most common irregular heartbeat, Atrial Fibrillation, from medical management to complex convergent procedures. Doylestown Health's Richard A. Reif Heart Institute is one of the top programs in the region in terms of success, safety and volumes performing procedures to treat irregular heartbeats.

About Doylestown Health's Heart & Vascular Services

Expert cardiologists and cardiac surgeons assist patients and physicians with managing risk factors for heart disease, offer advanced treatment options and provide outstanding emergency cardiac care. Doylestown Hospital’s accredited Chest Pain Center is fully prepared to treat cardiac emergencies around the clock, focusing on rapid diagnosis and effective treatment. The multidisciplinary team at the Woodall Center for Heart and Vascular Care is dedicated to providing the highest level of quality care and patient safety.

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