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Florence No Strings Attached

“I would absolutely recommend this pacemaker to anyone,” she says.

A Newly Available Wireless Pacemaker Gave One Patient A New Lease On Life.

Florence, 76, has stayed active and healthy her entire life. In her youth she loved fishing, waterskiing and sailing, and she now enjoys gardening and visiting her friends. So imagine her surprise when she found out her heartbeat was slow and out of rhythm. “I was confused,” says Florence, a longtime New Jersey resident now living in Ocean County. But the cardiology team at Community Medical Center (CMC) had the answer: a new “ wireless” pacemaker that regulates the heart’s rhythm with better patient comfort and a lower risk of complications than traditionally designed pacemakers.

The CMC cardiology team began implanting wireless pacemakers—a procedure that until recently was available only at hospitals that offered open-heart surgery—in the fall of 2018.

Off Beat

In March 2017, Florence’s primary care physician detected an irregular heartbeat with an electrocardiogram (ECG) during a routine physical. Her doctor referred Florence to the Community Medical Center cardiology team. CMC cardiologists Leonard DiPisa, MD, and John Merlino III, DO, confirmed the diagnosis with a second ECG.

Dr. DiPisa prescribed a blood-thinning medication to prevent clotting—a common complication from irregular heartbeat—which can cause a stroke.  During a routine follow-up ECG in September 2018, Florence’s heart rate dipped to 50 beats per minute (BPM) and was causing symptoms of fatigue. Slow  heartbeat, or bradycardia, prevents the heart from pumping enough oxygen-rich blood to needed organs. Her low heart rate placed Florence at risk for heart failure, high or low blood pressure, chest pains, confusion, fainting and, ultimately, stroke. “I didn’t understand what was happening,” Florence says. A clinical cardiac electrophysiologist, Dr. Merlino administered a 24-hour continuous ECG in early October to confirm the bradycardia
diagnosis, and then discussed with Florence how the wireless pacemaker could help control her heartbeat.

Small Size, Big Benefits

“Wireless pacemakers offer numerous advantages over traditional single-lead and multiple-lead pacemakers,” says Dr. Merlino.

One is that the inch-long wireless pacemaker is roughly 90 percent smaller than traditional pacemakers. Because of its small size, the wireless pacemaker is inserted through a catheter that is threaded near the groin, through a leg vein and up to the heart’s lower right chamber. The device is then attached to the heart with tines.

By contrast, traditional pacemakers consist of a generator, about the size of a wristwatch, and one, two or three wires (or “leads”) through which electrical pulses are sent to the heart. The wires are run through blood vessels in the chest and implanted in the heart, while the generator is implanted in the upper chest near the shoulder, where it can be seen under the skin.

“After you install a traditional pacemaker, the patient is left with a permanent lump or scar on the chest,” Dr. Merlino says. “With the leaderless pacemaker, there is no bump. The patient will forget he or she even has it.” More importantly, the tiny device controls heart rhythm without wires, or “leads.”

“Wires are the weak link in traditional pacemakers,” Dr. Merlino says. “In rare cases, the leads or wires can malfunction or become damaged over time.” Wireless pacemakers are safe as well as effective, Dr. Merlino notes. In a 2016 New England Journal of Medicine study, 98 percent of patients who received the wireless pacemaker had stable heartbeats six months after surgery and 96 percent experienced no complications or dislodgement.

Any patient who would benefit from a Leonard DiPisa, MD traditional single-lead pacemaker can be considered for a wireless pacemaker, but the new device cannot be used for patients who need a conventional two-lead (or dual-chamber) pacemaker to synchronize the heart’s ventricles or stimulate blood flow from the heart. “The wireless pacemaker was designed to function like a single-lead pacemaker,” Dr. Merlino explains. “The technology to mimic multiple-lead pacemakers has not yet been developed.”

Gain Without Pain

Florence agreed to receive the wireless pacemaker, and Dr. Merlino performed the implant October 24. The minimally invasive procedure takes 20 to 30 minutes, slightly less time than traditional pacemaker placement, but with reduced postsurgical pain. Wireless pacemaker recipients are kept at the hospital overnight and monitored for complications then released the next morning. “I didn’t feel anything after surgery,” Florence says, “maybe a slight pain in my groin from the small incision, but that was it. It was very easy.” Today, Florence is back home with her garden, and recently spent time with her brothers in Pennsylvania. She says she feels great.

“I would absolutely recommend this pacemaker to anyone,” she says.