Mini Pacemaker Makes Heart Surgery Easier for Children

A new study describes how a tiny pacemaker, about the size of an almond, leads to shorter surgeries, faster recovery times, and reduced medical costs.

Developed by Medtronic (Dublin, Ireland), in collaboration with researchers at Children's National Health System (CNHS; Washington, DC, USA), the uniqueness of the prototype miniature pacemaker lies in the PeriPath, a two-channel, self-anchoring access port that allows surgeons to insert a video camera into one channel in order to directly visualize the entire procedure. A sheath, inserted through the second channel, is then used to access the pericardial sac to affix the miniature pacemaker’s leadlet onto the surface of the heart, under direct visualization.

The final step is inserting the pacemaker itself into the one centimeter incision and closing it, leaving a tiny scar instead of two large suture lines. In a preliminary study of the percutaneous procedure, median time from incision to implantation was 21 minutes, and the entire procedure took less than an hour on average. In contrast, pediatric open-heart surgery can take up to several hours, depending on the child's medical complexities. The prototype pacemaker was presented at the American Heart Association (AHA) scientific sessions, held during November 2018 in Chicago (IL, USA).

“Advancements in surgical fields are tending toward procedures that are less and less invasive. There are many laparoscopic surgeries in adults and children that used to be open surgeries, such as appendix and gall bladder removals,” said study presenter cardiology fellow Rohan Kumthekar, MD. “However, placing pacemaker leads on infants' hearts has always been an open surgery. We are trying to bring those surgical advances into our field of pediatric cardiology to benefit our patients. As cardiologists and pediatric surgeons, our goal is to put a child's health and comfort first.”

“Placing a pacemaker in a small child is different than operating on an adult, due to their small chest cavity and narrow blood vessels. By eliminating the need to cut through the sternum or the ribs and fully open the chest to implant a pacemaker, the current model, we can cut down on surgical time and help alleviate pain,” concluded Dr. Kumthekar. “The advantage is that the entire surgery is contained within a tiny one centimeter incision, which is what we find groundbreaking.”

“The concept of inserting a pacemaker with a 1-cm incision in less than an hour demonstrates the power of working with multidisciplinary research teams to quickly solve complex clinical challenges,” added senior study author electrophysiologist Charles Berul, MD, chief of cardiology at CNHS, and inventor of the PeriPath self-anchoring access port, which was developed at the CNHS Sheikh Zayed Institute for Pediatric Surgical Innovation.