Dr. Harpreet Grewal with the Micra AV device
Dr. Harpreet Grewal with the Micra AV device (Photo courtesy Bon Secours)
A tiny device is giving new options to some people in metro Richmond in need of pacemakers.
The device is a Micra AV, and it’s about the size of a large pill. It is used in people with a particular type of blockage in the heart, an atrioventricular (AV) block, or impairment of the electrical signal from the upper chambers of the heart to its lower chambers. About 90% of AV blocks stem from ischemic heart disease (when some portion of the heart doesn’t receive enough blood) or fibrosis or sclerosis of the heart. That can lead to the heart skipping or missing beats and cause shortness of breath, fainting, fatigue and dizziness.
Pacemakers are the standard treatment. The devices regulate the electrical impulses between the chambers, and that increases blood flow. Standard pacemakers are placed in the chest under the collarbone and have wires that are attached to upper and lower heart chambers, The Micra AV is placed into the heart and does its work there. The device is smaller (about 95% smaller than a conventional pacemaker, according to its manufacturer, Medtronic) and less bulky, and the procedure to install it is less invasive: Instead of going through the chest to insert a device, the small device is inserted via a catheter that is threaded up from the groin and placed directly in the bottom right chamber of the heart. There are no wires to insert, and that lessens the risk of infection.
“There’s no comparison,” says Harpreet Grewal, a cardiologist and electrophysiologist with Bon Secours. He performed the first procedure with the device at Bon Secours Memorial Regional Medical Center earlier in the spring.
Grewal cites several upsides to use in the device.
A major factor is that it may reduce the risk of infection, a “game changer” for people at higher risk for infections, such as people with diabetes and those on dialysis, Grewal says. That’s because of factors such as the less invasive insertion process and the absence of wire leads in the device. Veins may develop scar tissue over time from having leads in them, and that risk is also eliminated with the Micra AV. Also, there are no needles inserted into the chest, so it eliminates the risk of puncturing a lung, according to Grewal.
In comparison with standard devices, Medtronic reports that the leadless pacemaker resulted in a 66% reduction in the risk of complications at six months.
It's also less intrusive. With a traditional pacemaker, elderly patients face a couple of weeks of post-operation restrictions, such as not raising the left arm for a couple of weeks and restrictions on movement, lifting and driving. People who receive the new device are able to walk about and climb stairs as they usually would by the next day. That may head off problems such as dislodgement that may occur with a standard pacemaker after it is first installed. Even small movements may change how a standard device detects irregular heartbeats and cause it to require an adjustment, something that’s not a worry with the micro device, Grewal says.
The Micra AV can only pace in the bottom chamber, so it’s not for everyone, Grewal notes. The device is covered for insurance and is appropriate for about 15% to 20% of people in need of pacemakers, he says.
Battery life is about the same for each type of device, about eight to 10 years.
The Micra AV device was approved by the U.S. Food and Drug Administration last year. Grewal has installed 10 as of early July, with favorable responses from recipients. “People love it,” he says. “They don’t even know it’s there.”
CAPSULES
Health and medicine news in brief
- The Delta variant of the novel coronavirus is in Virginia, and since December has accounted for 2.9% of the 3,052 reported infections caused by variants of concern that are tracked by the state, according to information from the Virginia Department of Health. The variants of concern are known as Alpha, Beta, Gamma and Delta. The Delta variant accounted for 37 of the 523 COVID-19 cases in the central region including Richmond, or 6.3%, the highest percentage in the five statewide regions. The health department updates information on variants of concern each Friday.
- VCU Health System has named Nina Hobcroft as its chief strategy officer. Hobcroft assumed duties on July 1 and will deal with strategic planning and initiatives, market positioning, and business unit growth and development, according to a release.
- About 59% of parents of children ages 12 to 15 in a recent statewide poll said that they would get their children vaccinated against COVID-19. About 53% of parents of younger children said they were likely to have their children vaccinated. African American parents were more likely than white parents to say they will have their children vaccinated, with 61% of African American parents of tweens and teens and 61% those with younger children favorable to vaccination, compared with 52% of white parents of older children, and 44% of those with younger children. The poll was conducted in May by the Research Institute for Social Equity at the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University for the Virginia Department of Emergency Management and released July 1.
