For the first, the AP-HP implants a pacemaker without a lead in a patient. The procedure does not require any incision in the chest.
A leadless pacemaker was implanted in a 65-year-old patient without surgery at the Georges Pompidou European Hospital (HEGP, Paris). This is the first time that a team from Assistance Publique-Hôpitaux de Paris has installed this type of pacemaker, 10 times smaller than a conventional device.
The patient suffered from bradycardia, a heart disorder responsible for slowing the rate generally below 50 beats per minute. To treat this condition, the pacemaker is the most common choice because it helps restore a normal rhythm by sending electrical impulses to the heart.
A revolutionary pacemaker
Since 1958, the year of the first implantation of such a device, the pacemaker consists of a battery and two probes. A case containing the battery is implanted under the collarbone and the leads are inserted into veins that go to the heart. These are the probes that bring electrical impulses to the heart to stimulate it and force it to beat faster. Indispensable, these probes are also the weak link in the system. Besides the risk of them rupturing or shifting, patients were also more likely to suffer from infection and venous thrombosis.
As a result, many research teams have worked on the development of a pacemaker without a lead. In France, the first installations took place in 2013 in Grenoble with the Nanostim, then in 2014 in Bordeaux with the Micra TPS. This miniaturized pacemaker contains the battery, the electronic system and the electrode. Despite its miniaturization, it lasts as long as a conventional pacemaker is between 9 and 13 years. It has proven its effectiveness during worldwide clinical trials coordinated in particular by the Bordeaux University Hospital.
15 implantations in 4 months
On December 28, the rhythmology team at HEGP implanted the Micra TPS leadless pacemaker. No larger than a euro coin, the device can be introduced through the femoral vein at the thigh level and up to the heart through a catheter. “The implementation of this pacemaker does not require an incision in the chest or the creation of a surgical ‘pocket’ under the skin, unlike current implantation techniques”, specifies Dr Eloi Marijon, cardiologist in charge of this first intervention. Two days after the operation, the patient was able to leave and is doing very well.
Experts assure that the speed and safety of the intervention should gradually promote its use in authorized centers, and replace conventional pacemakers. The HEGP rhythmology team plans to implant the pacemaker in 15 patients within the next 5 months. Since the beginning of January, three patients have already been implanted.
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