Beta

Slashdot: News for Nerds

×

Welcome to the Slashdot Beta site -- learn more here. Use the link in the footer or click here to return to the Classic version of Slashdot.

Thank you!

Before you choose to head back to the Classic look of the site, we'd appreciate it if you share your thoughts on the Beta; your feedback is what drives our ongoing development.

Beta is different and we value you taking the time to try it out. Please take a look at the changes we've made in Beta and  learn more about it. Thanks for reading, and for making the site better!

Tiny Pacemaker Can Be Installed Via Catheter

Unknown Lamer posted about 9 months ago | from the welcome-blood-robot-overlords dept.

Medicine 57

the_newsbeagle writes "About four million people around the world have pacemakers implanted in their bodies, and those devices all got there the same way: surgeons sliced open their patients' shoulders and inserted the pulse-generating devices in the flesh near the heart, then attached tiny wires to the heart muscle. ... A device that just received approval in the EU seems to solve those problems. This tiny pacemaker is the first that doesn't require wires to bring the electrical signal to the heart muscle, because it's implanted inside the heart itself, and is hooked onto the inner wall of one of the heart's chambers. This is possible because the cylindrical device can be inserted and attached using a steerable catheter that's snaked up through the femoral artery."

cancel ×

57 comments

This is exciting.. (4, Insightful)

mulvane (692631) | about 9 months ago | (#45145081)

The things we can do now adays in medicine are shocking...

Catheter? (-1)

Jeremiah Cornelius (137) | about 9 months ago | (#45145213)

Should they call it a "pissmaker"?

Re:Catheter? (3, Informative)

Russ1642 (1087959) | about 9 months ago | (#45145635)

Yes, it's a urinary catheter. To get to the heart. The two are directly connected, similar to your case where the brain is directly connected to the asshole.

Re:Catheter? (1)

newcastlejon (1483695) | about 9 months ago | (#45146953)

Should they call it a "pissmaker"?

They're probably saving that for the artificial kidney.

Re:Catheter? (1)

Jeremiah Cornelius (137) | about 9 months ago | (#45147747)

PissTake(tm) The artificial kidney and bladder system, that gives as good as it takes!

Believe me, urine for a treat!

Re:This is exciting.. (1)

Anonymous Coward | about 9 months ago | (#45145271)

The things we can do now adays in medicine are shocking...

I had a technique similar to this done almost 8 years ago. It was a radio catheter ablation done to correct atrial fibrillation. They went up through my groin and burned scars around my exiting heart valves to stop "Stray Voltage" in my heart. My heart hasn't skipped a beat since, and I was out of the hospital in just a day or two. This seems like a very logical next step, I can't imagine how much pain this is saving the patients.

Re:This is exciting.. (1)

Hognoxious (631665) | about 9 months ago | (#45145511)

The things we can do now adays in medicine are shocking...

Sadly there's no cure for junctural metanalysis [wikipedia.org]

Not as exciting as it used to be (1)

tlambert (566799) | about 9 months ago | (#45146133)

The things we can do now adays in medicine are shocking...

The article claims the thing can last "up to 13 years" before having to be replaced.

In the past, we used Pu-238 RTGs called "Plutonium cells", and the pacemakers never had to be replaced.

I guess this step backwards, towards treating pacemakers as a treatment, rather than a cure, guarantees a recurring revenue stream. One wonders, given the industry that surrounds it, whether we will ever get a cure for anything that started out with just a treatment, such as diabetes, when there's so much money tied up in "recurring revenue streams" and so little in "pay for it once". The whole SAS field itself is based on it.

Re: Not as exciting as it used to be (1)

ColdWetDog (752185) | about 9 months ago | (#45146263)

Maybe, perhaps, it's easier to treat a discrete problem (fast / slow/ intermittent ) heart rate than to solve the rather difficult problem of aging.

Think about it. They're not really after you.

Re:Not as exciting as it used to be (1)

joseph90 (193138) | about 9 months ago | (#45146307)

The things we can do now adays in medicine are shocking...

The article claims the thing can last "up to 13 years" before having to be replaced.

In the past, we used Pu-238 RTGs called "Plutonium cells", and the pacemakers never had to be replaced.

I guess this step backwards, towards treating pacemakers as a treatment, rather than a cure, guarantees a recurring revenue stream. One wonders, given the industry that surrounds it, whether we will ever get a cure for anything that started out with just a treatment, such as diabetes, when there's so much money tied up in "recurring revenue streams" and so little in "pay for it once". The whole SAS field itself is based on it.

The problem with the plutonium cells was that when you died you had to be buried as nuclear waste (or so I was told).

Re:Not as exciting as it used to be (1)

CastrTroy (595695) | about 9 months ago | (#45146909)

Why not just have the batteries removed after you're dead. It's not like the operation would kill you. You could probably get it done for free if you let med students do the task for you.

Whew! (5, Funny)

DaTroof (678806) | about 9 months ago | (#45145121)

Ah, through the femoral artery. My imagination went to a much more horrifying place when I read "catheter."

Re:Whew! (3, Funny)

Anonymous Coward | about 9 months ago | (#45145145)

I bet there's a market for electrostim prostate implants, though.

Re:Whew! (2)

Keith111 (1862190) | about 9 months ago | (#45145277)

I thought that science had finally proven that the path to a man's heart isn't through his stomach once and for all... :(

Re:Whew! (0)

Anonymous Coward | about 9 months ago | (#45145397)

They say an army marches on its stomach. After my wife's cooking, they *lie* on their stomachs! Budda-boom. Thank you, I'll be in the Catskills all this summer.

Re:Whew! (1)

FatdogHaiku (978357) | about 9 months ago | (#45145743)

I thought that science had finally proven that the path to a man's heart isn't through his stomach once and for all... :(

Yes, that was an old wives tale started to deny and suppress the "Happy Penis, Happy Man" axiom...
Old Wives be bitches sometimes...

Re:Whew! (1)

mcgrew (92797) | about 9 months ago | (#45147987)

I thought that science had finally proven that the path to a man's heart isn't through his stomach once and for all... :(

That old canard is misunderstood. The best way to a man's heart is through his stomach if you're trying to stab him to death.

Re:Whew! (1)

david_thornley (598059) | about 9 months ago | (#45157795)

It's bad enough. Ever had a catheter go to your heart?

It starts out fine. In my case, it was to pull a clot out of a coronary artery, and the heart attack pain just stopped very abruptly. Great.

Then there was the staying still for ten hours. I really don't know why it was so bad, but after about seven it hurt more than the heart attack had. When I talked about it to the nurses, they said they'd heard that a lot.

If there is a next time, I'm asking for the painkillers earlier.

MRI (0)

Anonymous Coward | about 9 months ago | (#45145141)

I wonder how susceptible these things are to strong magnetic fields in MRI machines. I'm not worried about it leaping out of someone's chest, a la Alien. I wonder if it can (if it even needs) to detect those fields and temporarily turn itself off like other pace makers.

Re:MRI (5, Interesting)

ChumpusRex2003 (726306) | about 9 months ago | (#45146049)

Probably a lot less susceptible.

The main concern with MRI and pacemakers is not so much the magnetic field but the RF field. The magnetic field is not without problems as most pacemakers contain a reed switch which is used to activate "safe mode", where the pacemaker enters a special diagnostic mode. This is largely for historical purposes, as early pacemakers used this for battery level testing. The doctor would hold a magnet to the patient's chest. The pacemaker would enter diagnostic mode and would stimulate the heart to beat a rate dependent on battery voltage. The doc would feel the patient's pulse and could look up the estimated battery level in a table.

Modern pacemakers contain rather more sophisticated NFC capability, so much more useful readouts are available with a proper scan tool (battery voltage, stimulation mode, inputs from various sensors, lead impedances, stimulation voltages and currents, etc.) as well the ability to reconfigure various modes (e.g. vibration response - where the pacemaker increases rate in response to exercise induced vibration), whether the pacemaker can sense other heart parameters (so that different chambers of the heart contract synchronously), etc. In general, however, a magnet will switch the pacemaker into a basic mode of operation. (Defibrillators are different, as basic stimulation can be very dangerous in people with severe heart disease, as it can trigger ventricular fibrillation; therefore magnet mode in implantable defibrillators usually only just tweaks some parameters, rather than anything more dramatic).

The major issue with MRI is the RF field. MRI requires a very powerful RF pulse. A typical MRI power amplifier will take up 6U of rack space, and about 5 gallons per minute of cooling water and need a 3phase 480V power supply, while providing a peak RF power output of 35-70 kW.

A modern pacemaker will typically sense the ECG as well as stimulating. It will include a watchdog timer, and if a beat is not detected before the timer expires, it will trigger a stimulation pulse. One risk with the MRI environment is that the capability of the pacemaker to sense the 1 mV ECG signal may be degraded by the pulsed transmission from the 70 kW RF transmitter 6 inches away.

There are other issues with conventional pacemakers. Being implanted near the shoulder, the pacemaker connects to the heart muscle via leads approx 8-12 inches long. These typically form an arc in shape due to the anatomy. It just so happens that this wire loop forms quite a nice 1/4 wave loop antenna tuned to the scanner's RF frequency; it can absorb the RF energy and channel RF into the tissues around the pacemaker "box" and at the electrode tips. In minor cases, the RF pulses can act as pacemaker pulses on the cardiac muscle. Fine at 1 Hz scan rate. Not so good at 5 Hz scan rate. In extreme cases, the voltage build up across the pacemaker leads can cause RF burns to the cardiac muscle or damage the pacemaker circuitry. (There are MRI compatible pacemakers around which use various tricks - upgrading from normal coax cables to coax with heavy copper screens so rigid that they actually have to be articulated in order to bend + a liberal helping of ferrite beads; or dividing the leads up into 1" segments interconnected by small ferrite transformers)

The nanostim device doesn't have any exposed leads, so it is likely to be much less susceptible to RF problems. Due to size and location, it's also likely that it doesn't feature a conventional magnet mode, relying instead completely on NFC for control and communication. It also has the option of being completely removable. Conventional pacemakers often aren't, as the leads are generally not retrievable from where they screw into the heart muscle. Because it is RF pick-up in the leads that is the No 1 hazard with MRI, simply removing the pacemaker device, but leaving the leads isn't a safe option (it may actually make it worse, as the pacemaker itself often contains clamping and termination circuits to protect itself from EMI, and this serves to absorb some of the RF pick-up from the leads).

So this looks like a very interesting device. However, by the looks of things it can only offer single "lead" functions (i.e. sense the presence or absence of a beat, and stimulate when a timer expires). This type of pacing is "asynchronous" as it is not synchornized with the top of the heart. In normal cardiac operation, the top (atria) of the heart beat first, pumping blood at low pressure to the bottom (ventricles) of the heart, where the pressure is boosted. In asynchronous pacing, cardiac function is reduced as the top and bottom stages of the heart are desynchronised. The preference with conventional pacemakers is synchronised pacing, where an atrial electrode senses the atrial ECG, and when a beat is detected, it triggers a ventricle stimulation after a physiological delay.

Re: MRI (1)

ColdWetDog (752185) | about 9 months ago | (#45146845)

Best posting on the thread. Tx

Re:MRI (1)

residents_parking (1026556) | about 9 months ago | (#45147893)

Wow - thanks for the detail. I spent two years working on a Defib tester with an option on a Pacer tester and for an EE the details can take some learning, especially when your client is in marketing. Most of the two years was spent grappling with immature technology and on UI, though I did have a bit of fun with pulsed biphasic capture in the early days.

Have you ever considered contributing to Wikipedia?

Re:MRI (0)

Anonymous Coward | about 9 months ago | (#45148455)

thank you for a nice technical description of the issues!

"Secretive" company (0, Troll)

Freshly Exhumed (105597) | about 9 months ago | (#45145189)

Patented to the hilt, I'm sure. I doubt there are any open source projects of this type, so once again humanity is gripped firmly by the invisible hand of the profit motive.

Re:"Secretive" company (1)

Anonymous Coward | about 9 months ago | (#45145291)

And, yet, it is our capitalist society which has managed to produce these amazing advances in such a short period of time. 60 years ago a pacemaker weighed 100 pounds and was worn externally. 10 years before that it didn't even exist except in theory. So, hate on capitalism if you want but I like it and wish we'd worry more about getting rid of some of the abuses than scrapping the whole system.

Re:"Secretive" company (0)

Anonymous Coward | about 9 months ago | (#45145429)

And, yet, it is our capitalist society which has managed to produce these amazing advances in such a short period of time

Along with massive, privacy-invading secrecy and mountains/islands of non-decomposable rubbish. Yay capitalsim!

Re:"Secretive" company (0)

Anonymous Coward | about 9 months ago | (#45170879)

Shout out to East German Communism!

Re:"Secretive" company (0)

Anonymous Coward | about 9 months ago | (#45145377)

oh come now. This is exactly why we have patents, so stuff like this gets developed and is available at all. On top of that they have to make all the info publicly available so others can build on it.

This is a tiny pacemaker implanted directly inside the heart without open heart surgery. This is not someone taking a patent form the 30s and adding the words "In the Cloud."

Re:"Secretive" company (0)

Anonymous Coward | about 9 months ago | (#45145677)

Patented to the hilt, I'm sure.

Yup.

I doubt there are any open source projects of this type,

It IS open source, that's what patents do; they give companies an incentive to open source their technology.

Open Source does not mean "Free to use", it means you're showing people what you're doing instead of keeping it secret.

Re:"Secretive" company (2)

HiThere (15173) | about 9 months ago | (#45148377)

That's what patents are supposed to be. That's also what they usually aren't. I don't believe in patents not only because they are generally something obvious, but because they generally do *not* "make patent" the devices that they are claiming a patent on. This may be an exception (though I haven't read the patent, and don't intend to). It is clearly the kind of thing that patents are intended to cover. So if the description does "make patent" the device, i.e. reveal it in sufficient detail that those skilled in the art can reproduce it, then I would consider this a valid instance of a patent. I estimate that this is true of perhaps 1 out of 1,000 patents, to be optimistic. Usually they are written in patent lawyer bafflegab and are of no use whatsoever to those skilled in the art that is not being described. I do not believe that those should be considered valid patents (and I do not so consider them). OTOH, I'm not a judge in a patent court. They seem happy to swallow any garbage and pronounce it valid.

Re:"Secretive" company (0)

Anonymous Coward | about 9 months ago | (#45146651)

Hate on profits all you want, but do not be a hypocrit by ever using any product ever developed by someone who made a profit on that device. On the other hand, we could drastically reduce the cost of health care by eliminating every device/drug which allowed someone to make a profit. Think how cheap your medical care would be then!

Quickest way (5, Funny)

The_Star_Child (2660919) | about 9 months ago | (#45145203)

The quickest way to a man's heart is through his catheter.

So, what if it's dislodged? (0)

Anonymous Coward | about 9 months ago | (#45145313)

Say, the patient takes a fall or some other shock to body - perhaps jogging lightly. Can the tiny device jump out of its place inside the heart? This sounds like an instantly deadly "clog".

Anyone else see this and think.... (2)

TheCarp (96830) | about 9 months ago | (#45145325)

"Well, there's a delicate corneal inversion procedure... a multi-opti-pupil-optomy. But, in order to keep from damaging the eye sockets, they've got to go in through the rectum. Ain't no man going to take that route with me! "

Sign me up! (4, Interesting)

Eggplant62 (120514) | about 9 months ago | (#45145349)

Around Christmastime 2011, I developed paroxysmal non-nodal reentrant supraventricular tachycardia, likely stemming from my maternal grandmother's history of similar cardiac problems, and underwent radiofrequency catheter ablation of the bad conducting circuit in my atrial tissue. I'm left with no fast pacing circuit to increase my heart rate on demand when I'm exercising. I know people with implanted pacer/defibrillators, and I work as medical transcriptionist and have typed a zillion of those procedures, and the things they despise about it is the problems with tissue pocket infections and interval battery replacements, requiring the site to be reopened, the equipment removed and replaced, antibiotic washout, reclosure, etc. I'll be bugging my doc at next visit to research it and determine if I can get one of these.

People need to stop living so long (-1, Flamebait)

Gothmolly (148874) | about 9 months ago | (#45145353)

"The greatest shortcoming of the human race is the inability to understand the exponential function."

Nobody wants to die, but now that society is picking up the endless tab for life-extending medicine on people who typically are outside the years in which they're productive members, surely some decisions need to be made.

Re:People need to stop living so long (0)

Anonymous Coward | about 9 months ago | (#45145399)

Goth Molly thath a pretty negative way to look at thingth....

Re:People need to stop living so long (0)

Anonymous Coward | about 9 months ago | (#45145621)

Don't worry. The humanity won't do anything it can't afford.

Re:People need to stop living so long (0)

Anonymous Coward | about 9 months ago | (#45145787)

But plenty of people with pacemakers are useful. You are just thinking of those that are walking 1000 year old mummies, which actually isn't most cases.

If their heart was so bad they couldn't be useful, they'd likely be incapable of living even with surgery and medical devices because the heart truly is the worst, crappiest organ in existence.
Hearts are the hard disk drives of biology. Slow, sluggish, break pretty easily if you mistreat it slightly (compared with other organs which only get upset, bad or get clogged), but very flexible and cheap to create.

On that note, are there any animals that actually have dual or more hearts? Or even no hearts and just pump-vein hybrids or something like that?
It would be a hard thing to evolve since evolution tends towards specialized or very varied use-cases and the heart being major falls under specialized, but lungs, kidneys are also major and there are 2 of those, likewise only one liver too.
And a pressure to push for 2 or more hearts is unlikely to happen because heart failures are an old-age related thing most of the time, long after they have likely had offspring.
Would be interesting if something has evolved that and how it got to that.

monkey spunk (0)

Hognoxious (631665) | about 9 months ago | (#45145423)

surgeons sliced open their patients' shoulders

Shit. Under a local anesthetic?

Re:monkey spunk (1)

Impy the Impiuos Imp (442658) | about 9 months ago | (#45146029)

They knock you out -- they have to test the automstic defibrillator part and you don't want to be conscious.

Re:monkey spunk (1)

joseph90 (193138) | about 9 months ago | (#45146275)

surgeons sliced open their patients' shoulders

Shit. Under a local anesthetic?

Yup. If you ask they will give you a valium (or equivalent). It does not really hurt.

Re:monkey spunk (1)

demonlapin (527802) | about 9 months ago | (#45146657)

Usually not, although the description is not entirely accurate - the shoulder joint isn't touched. The device is put just under the skin next to the collar bone.

What if it gets loose? (1)

Tony Isaac (1301187) | about 9 months ago | (#45145637)

If the pacemaker is in the heart, and it somehow got loose (maybe because of an imperfect installation), that could lead very quickly to a dead patient. Maybe they've tested for this, but the article doesn't say.

Re:What if it gets loose? (3, Insightful)

jklovanc (1603149) | about 9 months ago | (#45145845)

Considering it went through a medical approval process I bet all failure modes have been looked at. Just because an article does not enumerate every test done does not mean that they have not been done.

Re:What if it gets loose? (1)

tsotha (720379) | about 9 months ago | (#45147363)

Yep [discovermagazine.com]

So does this mean everyone lives forever (-1)

Anonymous Coward | about 9 months ago | (#45145701)

If medical science allows people to live forever, how are we going to know who is the genetic master race. Ohh yea that's right, The blacks and jews will gang up on the white people so they feel inferiour and do not reproduce.

Tell me when science invents a way to get off the planet. That will be a real breakthrough.

Technical correction and comment by a cardiologist (5, Informative)

cecst (2002578) | about 9 months ago | (#45145965)

The leadless pacemaker is indeed a real advance, but the summary needs a few corrections, and a comment can be made. I would not want a reader who needs a standard pacemaker to be frightened unnecessarily by the summary as written.
"surgeons sliced open their patients' shoulders and inserted the pulse-generating devices in the flesh near the heart, then attached tiny wires to the heart muscle ... through the femoral artery."
  • 1. The incision is made in the skin, not a joint. The implant location is usually the left or right prepectoral region, which is an inch or two lower than the collar bone on the stated side. The pacemaker itself is placed in a "pocket" formed by separating the skin and its attached fat from the underlying muscle. If you have ever eaten chicken, you know that the skin and fat can be separated from muscle. In the uncooked human, of course, separation requires a bit of effort but not much, and a good surgeon will have the area complete numbed up so the patient doesn't feel anything. Thus, the pacemaker is not near the heart: it's outside the rib cage. There are variations on the implant location, but none of them is inside the rib cage.
  • 2. The tiny wires (well, pretty tiny) are long, and extend from the area where the pacemaker is through a vein (not an artery, hopefully!) to the heart. The method by which the wires are put in the vein is simple but outside the scope of this post.
  • 3. The access is always through a vein (femoral vein, in the case of the new device), not an artery. Blood clots (thrombi, when inside the body) will form on most foreign bodies. From the veins, they can spread only into the lungs, which is relatively safe. From the arteries, even tiny thrombi can cause trouble when they go the brain (strokes), heart (heart attack), gut (ischemic gut), limbs (ischemic arm, leg, etc). Not good.
  • 4. The new device can still get infected and still can run out of battery power. What I haven't yet understood is how it can easily be extracted if it gets infected, which is necessary because life-threatening infection can (and usually does) result if an infected foreign body remains in the patient. I guess it's small enough that a new one can be inserted without removing the old one when the battery runs out. There are more technical limitations too that will likely be overcome as the technology improves.

Re:Technical correction and comment by a cardiolog (1)

demonlapin (527802) | about 9 months ago | (#45146687)

The video clearly shows it's venous access. I don't imagine you're want to be screwing a metal object into an active LV.

Re:Technical correction and comment by a cardiolog (0)

Anonymous Coward | about 9 months ago | (#45146719)

You would remove the old one before placing a new one, and can be removed percutaneously, same as it is put in.

Am I the only one? (1)

JTsyo (1338447) | about 9 months ago | (#45146023)

I'm more comfortable thinking about surgery where my shoulders are opened than thinking about something snaking up through my blood vessels from my leg. Though if I was to choose, the benefits would probably overcome my reservations.

Re:Am I the only one? (1)

Neil Boekend (1854906) | about 9 months ago | (#45150607)

I had an aneurysm (brain hemorrhage) a couple of years back. I can't remember anything about the operation, but they did such a procedure to install a platinum wire in the ruptured blood vessel. I must say, the alternative (sawing a part of my skull open and having a scar there for the rest of my life) seems way worse. If there had been an alternative, because the center of the brain is difficult if not impossible to operate on from the out side. From the inside it's relatively easy and you don't have to cut your way through healthy brain tissue in order to get to the problem.
During checkups they used a similar procedure to get contrast fluid in the proper place (so they didn't have to use as much). That time I was awake. It didn't feel invasive at all.

mr stud implants (0)

Anonymous Coward | about 9 months ago | (#45146089)

being able to knock a girl out is more important.

which is about the size and shape of a AAA battery (0)

Anonymous Coward | about 9 months ago | (#45146437)

A AAA battery will fit in one's femoral artery?

Prolly trough a vein (1)

Chewbacon (797801) | about 9 months ago | (#45146499)

I wouldn't want something implanted in my arterial system ready to shower clots in me. We don't put pacemaker leads in the arterial system, we put the leads through the venous system. Even a BiV pacer stunning the left ventricle does so through the venous coronary sinus.

reactions (0)

Anonymous Coward | about 9 months ago | (#45146569)

CT surgeons: We're the only specialists who should be allowed to do something like this argle bargle!

Interventional radiologists: Score!

Neat Stuff (1)

batteryman (245402) | about 9 months ago | (#45149009)

Can't wait to start working on this.

Check for New Comments
Slashdot Account

Need an Account?

Forgot your password?

Don't worry, we never post anything without your permission.

Submission Text Formatting Tips

We support a small subset of HTML, namely these tags:

  • b
  • i
  • p
  • br
  • a
  • ol
  • ul
  • li
  • dl
  • dt
  • dd
  • em
  • strong
  • tt
  • blockquote
  • div
  • quote
  • ecode

"ecode" can be used for code snippets, for example:

<ecode>    while(1) { do_something(); } </ecode>
Create a Slashdot Account

Loading...