Metro-East News

Pacemakers used to be the size of a baseball. This one, available locally, is the size of a pill.

St. Elizabeth's new pacemaker is one-tenth the size of a normal one

St. Elizabeth's Hospital in O'Fallon is now implanting a new, large-vitamin-sized pacemaker into patients.
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St. Elizabeth's Hospital in O'Fallon is now implanting a new, large-vitamin-sized pacemaker into patients.

Betty Lappe’s irregular heart rhythm made it a challenge for her to even walk from the front door to the car without becoming short of breath.

“It’s scary because you don’t know if you’re going to make it,” Lappe said.

The 80-year-old from Steeleville needed a pacemaker to treat her bradycardia, or slow heart rate, by sending electrical impulses to her heart to increase its pace.

Conventional pacemakers fit in the palm of your hand and are implanted under the skin through an incision above the heart. Wires connect the electronic device to the heart and keep it beating at a regular pace.

But Lappe wasn’t a conventional patient. She was the first to receive a new type of pacemaker — one that is a tenth of the size of a traditional device — at St. Elizabeth’s Hospital in O’Fallon.

The new device, about the size of a large vitamin capsule, is one of two recently developed heart health technologies available at St. Elizabeth’s that will help improve care and reduce costs. The other device, called CardioMEMS, helps monitor symptoms of congestive heart failure, notifying doctors a patient might be in need of a medication adjustment, possibly avoiding a trip to the emergency room.

The two devices mean metro-east and Southern Illinois patients can access new heart health care even closer to home, says Bonnie Schneider, director of Heart and Vascular Services at St. Elizabeth’s.

One of the world’s smallest pacemakers

Unlike conventional pacemakers, the new device doesn’t require wires or a surgical “pocket” beneath the skin. Instead, the device, known as the Micra Transcatheter Pacing System, can be implanted through a flexible tube inserted into a vein in the thigh that connects to the heart. The tube then extends directly into the heart and implants the device with small tines or prongs.

Once implanted, the device can’t be seen and is safer than conventional pacemakers, whose wires can sometimes cause complications, especially in high-risk patients like the elderly, very young or patients at a high risk of infection.

They don’t see a pacemaker scar every morning when they wash themselves, so they don’t have that constant reminder of their cardiac conditions.

Dr. Paban Saha, Prairie Heart and Vascular Institute of Illinois

Dr. Paban Saha, of the Prairie Heart and Vascular Institute of Illinois, performed the procedure for Lappe at St. Elizabeth’s on Jan. 4, the first time in the hospital’s history. The whole procedure takes about half an hour, Saha said, and most patients are able to leave the next day. It could eventually become an outpatient procedure, Saha said.

But the device isn’t for everyone, the doctor added. It only works for patients who need a single-chamber ventricular pacemakers, while conventional pacemakers still work effectively for patients who need double-chamber pacemakers.

“I think this is the future,” Saha said. “Once we get this in a two-chamber version or a three-chamber version ... then we minimize complications.”

Of the 726 patient participants in a 2015 global trial of the device, 99 percent saw success, according to the study published in the New England Journal of Medicine. More than 12,000 Micra devices have since been implanted worldwide, according to a company spokesperson.

The new device also eliminates the need for an incision on the chest or wires into the heart, Saha said.

“When there’s wires, patients have arm restrictions because I don’t want them to yank out the wires. So with this one there’s no wires, there’s no incision,” Saha said. “They don’t see a pacemaker scar every morning when they wash themselves, so they don’t have that constant reminder of their cardiac conditions.”

The device’s battery is designed to last from eight to 12 years, about the same as conventional pacemakers, Saha said. The device can be removed but, because of its tiny size, it’s possible doctors could simply place a new device right next to the old one, Saha said.

Developed by international health care technology company Medtronic, the device costs thousands of dollars to produce, but it qualifies for Medicare and insurance plans. It was approved by the United States Food and Drug Administration in April 2016.

St. Elizabeth’s President and CEO Peg Sebastian said the hospital chose to invest in the new technology because “it offers the newest and safest pacing therapy for our patients.”

Saha and Lappe_Micra TPS
Dr. Paban Saha, cardiologist with Prairie Heart and Vascular Institute of Illinois, holds a Micra TPS pacemaker, the smallest pacemaker in the world. Betty Lappe, of Steeleville was the first patient at HSHS St. Elizabeth’s Hospital to have the miniaturized heart device implanted to treat her slow heart rate. HSHS St. Elizabeth’s Hospital

Lappe, the 80-year-old patient from Steeleville, said she is feeling much better, adding that she didn’t experience any pain after the procedure.

“You don’t realize what it does to you when you can’t breathe,” Lappe said. “I can breathe a lot better now.”

A new way to track and manage congestive heart failure

Congestive heart failure is one of the most expensive conditions to diagnose and treat, and in the United States, more than 1.5 million people suffer from it.

It is also deadly. Heart failure occurs when the heart is unable to pump enough blood to the body, resulting in frequent hospitalization. In the past 10 to 15 years, less than 50 percent of patients diagnosed with congestive heart failure lived more than five years after diagnosis, according to Dr. Atul Shah, of the Prairie Heart and Vascular Institute of Illinois.

On Jan. 12, Shah became the first doctor at St. Elizabeth’s to place a CardioMEMS, a new monitoring device that could help keep patients out of emergency rooms and reduce costs on the health care system.

St. Elizabeth's Hospital in O'Fallon is implanting a new monitoring device into patients with congestive heart failure. The device helps doctors monitor a patient, possibly avoiding a trip to the emergency room.

One of the reasons heart failure is so difficult to treat is because it’s difficult to know when the condition is worsening. CardioMEMS allows doctors to monitor when a patient might need attention before they have to make a trip to the ER, Shah said.

Bill Simpson, of Swansea, has suffered from congestive heart failure for 12 years. He was the first patient at St. Elizabeth’s to have the device implanted.

Simpson, a 67-year-old who says people know him by his motorcyclist name, “Crash,” said he was in and out of the hospital within a day for the procedure. He went in for the procedure at about 8 a.m., the process took about a half-hour and he was released about five hours later.

Within four days, Simpson, got a call from Shah saying he needed to adjust his medicine based on information the device sent.

“He (Shah) knew when I was having a problem before I felt any difference,” Simpson said. “I’m a happy camper.”

In November and December, Simpson made five trips to the intensive care unit because of his condition. He said making an office visit is preferable by far.

“I’m gonna tell you, (it’s) a lot better than being in the ICU,” Simpson said.

A conventional pacemaker from St. Jude Medical is shown in this 2007 photo. Wikimedia Commons/Steven Fruitsmaak

A 2015 clinical study showed the monitor reduced hospital visits for heart failure by 33 percent over an 18-month period.

Like the new pacemaker, CardioMEMS is a tiny device implanted through a vein into the heart. Once in place, the device collects information that indicates increased pressure in the pulmonary artery, the artery that carries blood from the right ventricle of the heart to the lungs. Increased pressure can be an indication of worsening heart failure.

The information is sent on a daily basis to doctors, who analyze the results. All the patient has to do is lie on a “smart pillow” embedded with electronics. The pillow communicates wirelessly with the device and then securely sends information to doctors. It only takes a few minutes a day to send information, Simpson said.

“I can’t believe modern technology,” Simpson said.

The U.S. FDA approved CardioMEMS in May 2014. CardioMEMS is an Atlanta-based company and a subsidiary of Chicago-based Abbott Laboratories.

The Prairie Heart and Vascular Institute of Illinois is an organization of physicians partnering with Hospital Sisters Health System, or HSHS, with more than 45 locations across central and southern Illinois.

St. Elizabeth’s in O’Fallon is part of the HSHS hospital system.

Kelsey Landis: 618-239-2110, @kelseylandis