Cardiologists at Na Homolce hospital become first in Europe to implant world’s smallest pacemaker

Photo: Vojtěch Koval, Czech Radio

Cardiologists at Prague’s Na Homolce hospital implanted the world’s smallest pacemaker into a patient last week. It was the first operation of this type in Europe. Possessing new software that was partly developed by doctors at the hospital, the pacemaker has an increased longevity despite its smaller size.

Photo: Vojtěch Koval, Czech Radio

Nikola is just 23-years-old, but she has already had to undergo multiple operations due to her heart problems. This has not just impacted her freedom of choice when it comes to physical activities, but has also left her heavily scarred.

Petr Neužil, photo: Jana Přinosilová, Czech Radio

It was in part for this reason that she was selected to be the first European patient to receive a newly developed pacemaker, says cardiology professor Petr Neužil, the head of the Cardiology Department at Na Homolce hospital in Prague.

“She has really big problems with the so-called pacing threshold. That is the energy needed to develop a pacing spike contraction.

“Let us say that in terms of voltage this spike should be around 2.3 or 4 Volts. This young woman, since her second cardiac surgery, got a complete AV block and she is a patient 100 percent dependent on a pacemaker.

“However, her pacemaker threshold since her second cardiac surgery in 2010 was very high. The colleagues in other hospitals needed to exchange the leads and the pacemaker several times. Her last pacemaker lasted for about three years.

Pacemaker in heart, source: Archive of the Na Homolce hospital

“This small pacemaker, despite being only 10 percent of the volume of a regular battery, can last for 10 years. Why? Because the pacing energy for this patient was brought down from the regular 5 Volts to 0.5 Volts. We assume that she will get a huge profit from this new leadless pacemaker.”

The instrument benefits from new software, which was partly developed by doctors at the Czech hospital, says Professor Neužil.

“In 2012, when the first implantation of the leadless pacemaker was done, we used only single chamber, single ventricle pacing. That means that the pacing spike was not really responding to the atrium component.

“We have an atrium and ventricle chamber in the heart. In order to get a 100 percent cardiac output the contraction of the atrium should correspond with the contraction of the ventricle. The new pacemaker optimises the ventricle and chamber cooperation.”

Photo: ČT24

To do so, the pacemaker uses three sensors in the body to detect the mechanical functions of the right and left atrium.

In the eight years since it was introduced, around 7 to 10 percent of patients with heart issues have received the original leadless pacemaker. According to Professor Neužil, the new design will extend the applicability of wireless pacemakers considerably, with up to a half of patients with heart problems becoming potential users.

While this may seem like a major advance, Professor Neužil says that an even bigger revolution is likely to arrive soon.

Na Homolce hospital, photo: Tomáš Adamec, Czech Radio

“This is a new kind of evolution, because leadless pacemakers are a sort of new paradigm in cardiac pacing. I expect that this kind of VDD pacing is one step forward towards getting multi-chambered leadless pacemakers. We should be able to implement right atrium, right ventricle and even left ventricle pacing.

“The end of this story should be multi-chambered leadless pacemakers. We are currently working on that and I suspect we should get the first multi-chambered leadless pacemakers in about two years.”