World’s smallest pacemaker reacts to stress

By Malka Eisenberg

Science fiction is now fact on Long Island.

The world’s smallest pacemaker, uniquely able to respond to emotional stress and remotely alert the patient’s doctor to any adverse events, was recently implanted into the chest of a 50-year-old man at South Nassau Communities Hospital.

“The patient is doing great,” said Dr. Lawrence Kanner, director of electrophysiology and arrhythmia services there. “He hasn’t passed out” since the implant.

Biotronik’s Evia pacemaker is twenty percent smaller than current pacemakers in use and has a longer battery life of ten years; batteries in other units need replacement in five to seven years. The Food and Drug Administration approved its use in May. Shortly thereafter it was implanted in a patient in Toledo, OH. Before the FDA approved the Evia it was in use for a year in Europe.

A pacemaker is a small appliance that is generally inserted in a patient’s chest and has small wires attached to the heart muscle. It uses mild electrical stimulation to assist the heart to maintain a normal rhythm in someone who has an irregular heartbeat, or arrhythmia. Shortness of breath, fatigue, dizziness, chest discomfort and fainting are some symptoms of arrhythmia.

A typical pacemaker is monitored at office visits and may interact with a device that “looks like a remote control that sits on the patient’s chest and communicates with the pacemaker via infra red,” explained Dr. Kanner. Another type of monitoring is “through the telephone but only battery and overall function” can be determined,” he said. “It’s remote but not wireless.”

With the Evia pacemaker “the home based monitor interacts wirelessly with the pacemaker and is completely mobile via cell phone technology,” Dr. Kanner explained. The doctor would have an account with Biotronik and the pacemaker is usually monitored quarterly. The monitor sends a signal for the pacemaker to check itself and the message is sent via phone to Biotronik to the doctor’s account and the doctor is alerted, Kanner continued. He pointed out that all pacemaker companies have the ability to monitor their pacemakers but Biotronik “put in the ability to get the message to the doctor, having the pacemaker checking at home and notifying the doctor. The pacemaker self checks several times a day. If it has a dead battery or broken wire it sends an alert via the monitor through internet-based remote monitoring. In such a life threatening situation the doctor can be paged or faxed. The doctor can be found.”

Kanner said that Evia’s most “novel feature” is closed loop stimulation, linked to the autonomic nervous system. “It gets an idea of what the blood pressure is by looking at electrical readings,” explained Kanner. “It does a pretty good job of restoring the autonomic nervous system.” Most pacemakers only control the heart rate, he said.

“Some people pass out when the blood pressure is dropping,” he continued. “It senses the drop before the problem (sets in) and starts pacing more rapidly to maintain blood pressure. It’s the only pacemaker that responds to emotional stresses. All respond to motion such as walking faster. The Evia can respond to emotion. If someone is sitting at an intense game of cards and not moving, [closed loop stimulation] responds to that.”

“There are all kinds of reasons for a pacemaker,” Kanner pointed out. “Most patients have a routine pacemaker. The Evia is for specific issues.”

“It’s not normal to be dizzy and passing out and fatigued,” Kanner stressed. If someone has these symptoms, “the patient should see a cardiologist and be evaluated.”