Miniscule cardiac devices that improve and save lives

LACONIA — Dr. Adam Chodosh, and Dr. Patrick Magnus, of Concord Hospital Cardiology recently discussed various cardiac devices at a panel presentation in Laconia that featured numerous providers from the Concord Hospital Cardiovascular Institute. Dr. Chodosh is an electrophysiologist and the medical director of the Concord Hospital Electrophysiology Lab as well as the Arrhythmia and Device Clinics. Dr. Magnus is an interventional cardiologist and the medical director of the Cardiac Catheterization Lab and Structural Heart Program.

What are cardiac devices?

Cardiac devices are implantable objects or tools that aid heart healthcare in some manner. Stereotypically people think of basic pacemakers or defibrillators, but the science is continuously evolving and we have exciting new options and improvements available today. The latest devices have the remarkable capability to talk to a computer through radio frequency or Bluetooth. For instance, an abnormal heart rhythm can be detected by a device, which then sends that information to a computer alerting a patient’s healthcare provider. The patient would then be started on a blood thinner or another action would be taken to prevent a stroke from happening.

Are pacemakers still used?

Absolutely, but they have undergone wonderful innovations in both device design and placement procedure. The newest iteration of the pacemaker, for example, is called the Micra. Where traditional pacemakers were larger, required leads and were implanted in the chest, the Micra is only about the size of a nickel, is implanted directly into the heart and requires no leads. This tiny device is inserted into the heart through a minimally invasive procedure and is revolutionary for the patients whose hearts need pacing assistance. Different devices such as the Watchman and the Impella can be implanted to help with other issues.

What is the Watchman?

The Watchman implant is a small device that is implanted directly into an area of the heart called the left atrial appendage. Patients with atrial fibrillation, an abnormal heart rhythm, have a five times greater risk of stroke than those without. Research has shown that in patients with atrial fibrillation, 90 percent of strokes emanate from the LAA as clots are frequently formed in the appendage. The Watchman device, which is inserted in a minimally invasive fashion, acts as scaffolding for the body’s own tissue formation, which grows over the implant blocking off that area of the heart from the bloodstream. Once the LAA is occluded, or blocked off, clots can no longer form in the appendage and stroke risk is greatly reduced. This device has been shown to be as effective as blood thinners and allows for the prevention of stroke in patients that cannot safely take such medications.

What is the Impella?

Unlike the more permanent Micra and Watchman devices, the Impella is used on a temporary basis during high-risk coronary artery interventions. It supports patients with low blood pressure due to left heart failure, right heart failure or both. The device is inserted in a minimally invasive manner into the ventricle and assists the heart in pumping, allowing it to rest during a procedure.

Are there any other cardiac devices?

Yes, there are numerous other cardiac devices in use today: far too many to mention here. However, as an example of the plethora of innovation in this field, there are four different types of endovascular atherectomy devices used to clear out plaque that is narrowing or blocking arteries. They are classified as rotational, orbital, directional, or laser atherectomy devices depending on the mechanism used to debulk the buildup and blockages. Even as we have a variety of exciting options available currently, devices are constantly being engineered or improved as the medical field works to better cardiac care.