Advances in cardiac medical technology save lives every day. But how can future innovations meet the needs of today’s patients even more?
By engaging not only with clinicians but also with patients and people at risk of cardiovascular events, our sector is ensuring that advances in technology focus on their quality of life. For example, less invasive procedures and remote monitoring of implantable devices are addressing patients’ call for technologies that allow them to get on with living life.
This can be illustrated by looking at some of the technologies that help to regulate patients’ heartbeats, including pacemakers, defibrillators and cardiac resynchronization therapy devices. First, let’s briefly consider some of the major problems that can arise in heart health.
The heart is a muscle that pumps blood through the body. For the heart muscle to contract it needs oxygen (blood supply) and an electrical pulse (rate & rhythm). The two main problems that can occur are obstruction of vessels supplying the heart muscle with blood (heart attack) and problems with the electrical pulse formation and/or conduction (heart rate too fast or too slow). These two problems may be linked: people who have suffered a heart attack or have heart failure, are at higher risk of electrical pulse formation and/or conduction problems, including sudden cardiac arrest (SCA).
Keeping pace with technology
A healthy heart beats 60 to 100 times per minute, pumping about 280 litres of blood every hour. For some people, the heart can beat too slowly, causing dizziness, chronic lack of energy and shortness of breath. This is known as bradycardia. This condition can be treated in some patients by implanting a pacemaker that restores a normal heartbeat.
Pacemakers have come a long way in a relatively short time. The traditional pacemaker is a small device implanted under the skin, usually near the collarbone. Thin, soft wires carry an electrical impulse from the device to the heart. Newer pacemakers are even smaller and have no leads. Instead, they are placed directly into the heart through a vein.
Of course, it is vital that the pacemaker is performing correctly. That’s why check-ups are required to monitor the battery and check the leads if applicable, and if necessary, update the device parameters using a computer.
By listening to patients, we heard that these regular check-ups are highly valued but making frequent trips to the clinic can be a burden. That is among the reasons why the latest wave of innovation in pacemakers and other implantable heart devices has delivered remote monitoring. Remote monitoring (RM) allows patients to stay connected to their clinical care team from the comfort of their own home or even while travelling – the relevance and importance of RM has increased even more since the outbreak of COVID-19.
Not only is it more convenient to have a device check-up without making an in-clinic appointment, but the RM technology also allows earlier detection of potential problems and addressing these more quickly, which offers peace of mind to patients.
Rapid heart beats
While we know slow heart beats can be problematic, it can also be dangerous when the heart beats too fast – a condition known as tachycardia. Tachycardia can make the heart beat up to 400 times per minute, thereby increasing the risk of sudden cardiac arrest (SCA). SCA causes around 20% of all deaths in Europe.
SCA can be addressed by a defibrillator, of which there are two main types. One is an automated external defibrillator (AED) – a portable device used by emergency response teams or the general public to shock the heart if it stopped suddenly. The other is an implantable cardioverter defibrillator (ICD) which is placed under the skin and delivers electrical pulses including shocks.
The ICD is like a small computer that continuously monitors the heart and automatically delivers electrical pulses to correct fast heart rhythms. It is connected to the heart through small leads, about the size of a spaghetti noodle.
The procedure to implant an ICD requires a small incision to be made in the chest, through which the leads and the ICD can be inserted. This is a minimally invasive procedure which allows most people to go home within 24 hours. That represents a major advance on the earlier waves of cardiac implants which involved more invasive surgery which required longer recovery times and carried higher risks.
As with pacemakers, ICDs can be monitored remotely using a small bedside monitor or a smartphone app. This allows communication between the device and the patient’s health professional if an irregular rhythm is detected.
We continue to see advances in ICDs which allow patients to live normal lives. Traditionally, most ICDs were not considered safe to use in an MRI (magnetic resonance imaging) scanner. However, the latest innovative technologies are designed to overcome this limitation, ensuring that patients’ healthcare options are not limited by their implanted device.
Managing heart failure
People with heart failure can endure significant declines in their quality of life. The heart muscle is unable to pump enough blood to meet the body’s needs, patients feel tired, lack energy and may be short of breath. The heart may beat in an uncoordinated and inefficient manner.
One way to help manage heart failure is by implanting a cardiac resynchronisation therapy (CRT) device. These devices are specialised pacemakers or defibrillators that help to resynchronise the heartbeat.
As with the other technologies described above, advances in remote monitoring bring new benefits to patients, while the old problem of having to avoid MRI scans has also been solved.
Taken together, modern cardiac technologies show how far medical technology has come in addressing the needs of patients. Our shared goal remains to save lives and improve the quality of patients’ lives.
This is best achieved by working together with patients, from the early research priority setting and product development to educational materials, peer testimonials, addressing questions about living with cardiovascular devices. In this way, we strive to deliver innovation that matters to patients and improves their lives.