For patients seeking pacemakers, options abound

Retired professor Bill Bogard plans to celebrate his 77th birthday in April with a 100-mile bike ride.

“I’m riding faster, stronger and longer than I’ve ever ridden before,” he said.

Bogard, a heart patient, credits cardiac ablation, a medical procedure used to correct irregular heart rhythms, and a new pacemaker that can detect when he is exercising.

Doctors say finding the right pacemaker can be key to living a high-quality life.

“For most people who are elderly and don’t get around much, almost any pacemaker will meet their needs,” said Dr. Raul Mitrani, an associate professor and director of clinical cardiac electrophysiology at the University of Miami Miller School of Medicine. “More active people really need to consider having a good talk with their cardiologist to pick the right one.”

There’s another cutting-edge option available at the Miami Cardiac & Vascular Institute at Baptist Health South Florida, where doctors are conducting clinical trials with a new miniature pacemaker.

“This is a groundbreaking technology that is going to change how we put in pacemakers and treat patients,” said Dr. Hakop Hrachian, an electrophysiologist at the Miami Cardiac & Vascular Institute at South Miami Hospital and co-investigator for the clinical trial.

Pacemakers are small devices that help regulate one’s heartbeat. Most are the size of a silver dollar, and are implanted under the skin in the upper chest. They deliver electrical impulses to the heart through one or two wires known as leads.

Hrachian described a pacemaker as “a substitute for the heart’s own conduction system and electrical power plant.”

“There is no medication to increase the heart rate safely and permanently,” he said. “So for many decades — more than 50 years — the traditional treatment for slow heartbeat has been a pacemaker.”

Past surgeries

Bogard, the retired professor, had his first open-heart surgery when he was about 50 years old. He had his second a decade later.

The second surgery was a wake-up call, Bogard said. It prompted him to start biking.

Bogard’s heart was functioning properly — until his heartbeat dropped from 145 beats per minute to 35 beats per minute in the middle of a 100-mile ride along Florida’s Space Coast. He almost crashed.

He went to see Mitrani at the University of Miami Miller School of Medicine the next day.

Mitrani diagnosed Bogard with sick sinus syndrome and an extreme form of arrhythmia, or abnormal heart rhythm. He tried controlling the condition with medication. When that didn’t work, Mitrani tried ablation, a procedure that can stop certain nerves from firing. (In an ablation, a doctor guides an electrode with a tip to the area of the heart where the misfires are occurring and uses the electrode tip to burn off the cells causing the irregular heartbeat.)

“That essentially cleared me up,” Bogard said.

The next step: finding a pacemaker.

Most pacemakers monitor how quickly a person is accelerating and adjust his or her heart rate accordingly. But because Bogard is a cyclist, Mitrani recommended a more sophisticated pacemaker with two sensors: one that detects motion and acceleration, and one that measures the patient’s respiratory rate.

“By tracking his repository rate — or by seeing that he is breathing fast — the device knows to make the heart rate match that increase in respiratory rate,” Mitrani said.

Mitrani fine-tuned the device last year by having Bogard ride a stationary bike in his office.

“We programmed it in a way to match his activity, so when he is cycling very fast, his heart rate goes to a comfortable level that maintains the output of the heart to meet the needs of his body during exercise,” he said.

The new pacemaker has allowed Bogard to keep a busy schedule. He plans to participate in a 150-mile race from Miami to the Keys next month to raise money for multiple sclerosis. His birthday ride will take place April 19.

“I’ve been their guinea pig,” he said. “I’ve been pushing the limits of their pacemaker.”

CLINICAL TRIALS

Doctors at the Miami Cardiac & Vascular Center at Baptist Health, meanwhile, are running clinical trials with another type of pacemaker. The new technology, roughly the size of a vitamin, is attached to the inside of the heart.

To implant the device, doctors run a catheter to the heart through a vein in the groin. No surgery is required.

“This is all done under X-ray,” said Hrachian of South Miami Hospital. “The patient is awake to watch it.”

There are other benefits, said Dr. Efrain Gonzalez, medical director of electrophysiology at Miami Cardiac & Vascular Institute at Baptist Hospital and the principal investigator on the study.

“There is no risk of infection, there is no risk of lead failure,” Gonzalez said. “All of those problems are bypassed by eliminating the leads.”

The clinical trial is running in 18 countries and 50 medical centers in the United States. The Miami Cardiac & Vascular Institute is the only participating medical center south of Jacksonville. (The trials are taking place at both South Miami Hospital and Baptist Hospital locations.)

So far, “the results have been phenomenal,” Hrachian said.

Gonzalez, who has implanted 11 of the devices, said his patients are “all very happy with the results.”

“They are all back to work or their family activities,” Gonzalez said. “One of my patients was miserable after open-heart surgery. He came in today like a new man.”

Walter Parrish, who had the procedure in December, said he is pleased with the results.

“Dr. Gonzalez showed me the old style, and then he showed me the new, smaller technology,” he said. “I figured, if it has to be done, I’d rather do the little one than the big one.”

It took only days for him to be completely recovered, he said.

“I’m able to walk and ride my bike,” Parrish said. “I don’t do any heavy manual labor, but I’m able to sightsee and do about anything I want to do.”

Parrish said he has already recommended the device to his neighbors at the Larry and Penny Thompson Campground in southern Miami-Dade County.

“I’ve talked to several people here in the park who have pacemakers, and they wish [the new technology] had been available for them,” he said. “It’s been great.”

This story was originally published February 20, 2015 at 3:27 PM with the headline "For patients seeking pacemakers, options abound."