CHARLOTTESVILLE, VA (CVILLE RIGHT NOW) – UVA Health doctors have become the first in the mid-Atlantic to implant a new wireless pacemaker in patients.

In a media briefing, Dr. Oliver Monfredi, an electrophysiologist specializing in heart rhythm disorders, explained that unlike traditional pacemakers the new leadless pacemaker system WISE CRT uses soundwaves transmitted to a tiny rice-sized electrode placed in the heart’s left ventricle.

“Whilst we have leadless pacemakers that pace that right bottom chamber of the heart, we’ve had those for around 10 years,” Monfredi said. “The beauty of this new system is that it is the first kind of leadless pacemaker that is capable of pacing the left bottom chamber of the heart, the left ventricle, which is, in effect, the most important chamber of the heart, because it squeezes blood around our, you know, around our vital organs, including our brain, our kidneys, our liver, you know, things like that.

“So the left ventricle, which is where this pacemaker is implanted, hasn’t historically had a leadless pacemaking technology to be able to resynchronize the heart.”

The procedure involves implanting both a generator and battery under the skin, along with the electrode, and can benefit patients with heart failure who require resynchronization pacing.

Monfredi noted that this technology is particularly valuable for patients who have had tricuspid valve interventions, as it avoids the complications associated with traditional pacing leads in that area.

“The electrode itself is tiny, remarkably tiny. It’s about the size of a grain of rice. 0.05 cc’s,” Monfredi said. “And it is coated in a polyester fabric, which allows the heart to, what we call, endothelialize over the top of it, which means essentially grow a thin layer of tissue, which is important to patients, because what it means is that they don’t need to take any blood thinning medication to prevent clots from forming on the grain of rice electrode.”

He said they implant it in two components in one sitting.

“The first component of it is the implantation of the impulse generator and the associated battery, which go underneath the skin,” Monfredi said, “So patients sleep completely under general anesthetic. We make a small cut on the front wall of the chest, in the area just in front of the heart. And we place the transmitter in between two ribs, and we sew it down. And then we tunnel the lead from the transmitter itself around the side to under the arm area, which is where the battery sits. So we connect up the lead, which connects to the transmitter, to the battery. So, transmitter’s up front, in front of the chest, between two ribs. The battery is around the side, so out of the way, which is a patient satisfier, because it means, you know, it’s kind of easy to forget about it if it’s under your arm.”

Monfredi explained, “Then the second stage of the procedure is the implantation of the electrode, right? And so, that little grain of rice has to get to the left lower chamber of the heart somehow, and the way that we do that is we use the vein at the top of the leg.”

“And we pass, under x-ray, a catheter up into the right top chamber of the heart, and we cross over the thin membrane that separates the right top chamber of the heart from the left top chamber by doing what we call a transeptal puncture. Once we’re in the left top chamber, it’s a simple matter of just going through the valve, the mitral valve that separates the left top chamber to the left bottom chamber, and that’s how we get there.”

He and electrophysiologist colleague, Dr. Pamela Mason, conducted trials prior to FDA authorization, and are now doing it procedurally.

“There are new technologies in that, in which we lead the nation, if not the world, you know, with those as well,” said Monfredi. “And so, you know, we’re not just using the old technology because we’re familiar with it, which is, I think, a risk elsewhere. We have an extremely progressive approach to selecting the right device with the patient in mind. And there is no commercially available device in pacing or defibrillation that patients at UVA can’t benefit from. We offer everything that’s available.”

He said that can’t be said to be true everywhere.