We echo a very interesting interview that the newspaper La Razón conducted with the head of the Cardiovascular Surgery Service of the Hospital Quirónsalud Sagrado Corazón of Seville and the director of the Arrhythmia Unit of the Hospital Quirónsalud Sagrado Corazón of Seville. Direct link to La Razón
1. What do wireless pacemakers look like?
Dr. Fernández Gómez (F. G.): They are thimble-sized devices that are inserted into the heart muscle (specifically the right ventricle) percutaneously, through the femoral vein and through a system of catheters. Once inserted, the instrument works autonomously, without the need for cables, since it has a small battery. This device integrates all the components of a pacemaker, i.e. batteries, circuits and small antennas that replace the wires and directly stimulate the heart.
2. What are the advantages of this device for the professional?
Dr. F. G.: It offers an alternative mode of stimulation and in certain patients it is the only option.
3. And what benefits does it bring to the patient?
Dr. F. G.: It means dispensing with the “Achilles heel” of pacemakers, which are precisely the wires that connect them to the heart. Most of the problems that can arise in the long term in a patient with a pacemaker are related to these wires: displacement, infection, breakage, deterioration, etc… Therefore, the appearance of devices that do not require wires means that the problems associated with them are eliminated.
4. What kind of people is the use of a pacemaker without wires specially thought for?
Dr. F. G.: For those who, for different reasons, lack adequate venous access, either because of infections, malformations, obstructions or thrombosis, it is the only option to insert a stimulation system. These patients, until now, had no other alternative than open surgery for insertion of epicardial leads (on the external face of the heart). They are also indicated in those who still have some leaky veins, but have had a wire infection. With this pacemaker we can eliminate the risks of new infections, a pathology that is more frequent in those who have already presented it before.
5. Can any patient wear a pacemaker of this type or is it contraindicated in some cases?
Dr. F. G.: Wireless pacemakers are not a replacement for the conventional systems that have existed up to now, but a complement to them, at least with the technology that is currently available. Therefore, although there are no formal contraindications for any particular patient, they are reserved for the groups mentioned.
6. How are these devices placed?
Dr. Gómez Vidal (G. V.): The technique is completely percutaneous. The venous system is accessed through the femoral vein. It is dilated with successive introducers, and through a large-caliber catheter the device is inserted into the interior of the ventricle. The method is similar to the venous cannulations performed in cardiac surgery or in catheter ablations and other interventional procedures.
7. In what type of cardiac pathologies are they especially indicated?
Dr. F. G.: The indication is the same as for a conventional pacemaker, that is, in cases of bradycardia due to heart block. We currently have available a first generation of pacemakers without wires that only allow the right ventricle to be stimulated, although we are already working on more advanced models that will allow stimulation in two or even three cardiac chambers, which will make it possible to bring them into line with conventional pacemakers and increase the indications.
8. Until now, the only solution in medicine was an incision. What does it mean for Cardiology and Cardiovascular Surgery to avoid these interventions?
Dr. G. V.: It is one more option. It avoids surgeries to implant electrodes on the outside of the heart (epicardium), through a direct incision in the chest. These are not very aggressive surgeries, but they always pose a risk in patients weakened by other pathologies, and they continue to depend on the functioning of wires, in this case on the surface of the heart.
9. What innovations are coming to the consultation to facilitate the work of professionals?
Dr. G. V.: Cardiovascular therapies have undergone unprecedented technological evolution in the last decade, so that today we are able to treat, with good results, many pathologies that previously lacked an effective treatment or that represented a greater risk. Some examples of this are TAVI (percutaneous aortic valve implantation); ablation of complex arrhythmias using cardiac navigators or cryoablation; advanced cardiac stimulation techniques, such as pacemakers without wires or His bundle pacemakers (which achieve absolutely physiological stimulation); the correction of valve defects with “mitraclips”, or percutaneous stents for the treatment of aortic pathology. The multidisciplinary team at Quironsalud-Neoláser Cardiovascular has all the technical and human resources necessary to carry out these techniques and continually incorporates all the advances that arrive in this area.
10. What challenges are ahead for Cardiology and Cardiovascular Surgery?
Dr. G. V.: We believe that there are two fundamental challenges. On the one hand, the fact that this is a sector in constant technological renovation forces professionals and hospitals to make a considerable effort to keep themselves permanently updated. On the other hand, as the complexity of the techniques and the specialization of the professionals increase, a model of teamwork is necessarily imposed. In our field, this concept has become popular with the name of “Heart team”, and basically consists of the integration of clinical cardiologists, interventionalists, arrhythmologists, cardiac and vascular surgeons, anesthesiologists, intensivists and nurses in the same work and decision-making team, which is fundamental to the success of the interventions.
To see the original news follow this link to La Razón Newspaper
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