April 14, 2024 • 28 mins
04/14/2024
The Healthy Matters Podcast
S03_E11 - Keeping Up with Pacemakers
The heart is pretty amazing. In the orchestra the human body, the heart is the conductor, but sometimes, even the most skilled maestro needs a little backup. Enter pacemakers, the tiny conductors that can help us keep the beat. But when might you need one? How are they implanted? How long do they last? And can I still use the microwave?
Join us to learn about the world of pacemakers with our guest, Dr. Rehan Karim. He's an electrophysiologist (fantastic scrabble word, btw...) and he'll walk us through some basics on the electrical system of our hearts, how pacemakers work, what the lived experience is like with one, and some of the latest developments for this amazing technology. Did you know that the first pacemaker was made in MInnesota? Find out more about these life-changing devices, on Episode 11!
You can learn more about heart health issues and find helpful resources here.
Got a question for the doc or a comment on the show?
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:19):
Hey everybody. Dr.
David Hilden here, and welcometo episode 11 of the podcast.
Today we're gonna talk to Dr.
Rahan Kareem. He is anelectrophysiologist. What's
that you say? Well, he's acardiologist who specializes in
the electrical systems of yourheart. Dr. Kareem , thanks for
being here.
Speaker 3 (00:34):
Thank you for having me here. It's
Speaker 2 (00:35):
Great to have you here. And I'd like to focus
today on pacemakers. Uh, I knowyou do a lot in your job, and
we'll maybe get you back on afuture episode to talk about
other things, but today I wannatalk about pacemakers and what
do they do and why are theyused, things like that. So,
could you start us off and tellus what's the function of a
pacemaker?
Speaker 3 (00:53):
First of all, thank you again for having me here.
In simplistic terms, the onlyjob of a pacemaker is to
prevent the heart from goingtoo slow. For whatever reason,
heart rate is going very slow.
That is making someonesymptomatic. Then the job of
the pacemaker is to make surethat there is a minimum heart
(01:16):
rate that it provides.
Speaker 2 (01:17):
So it sets the pace.
Yes. So what's the problem? Ifsomeone's heart's going too
slow?
Speaker 3 (01:22):
They could have a lot of problems. The main
complaint , uh, people canpresent with is feeling dizzy
or lightheaded. Or if heartdecides not to beat for a few
seconds, a person can actuallypass out and injure themselves.
They can feel fatigued. Anormal person, if they start
running or the physicalactivity goes up the heart, the
(01:46):
human body , uh, has an amazingway that it can sense that body
needs more blood supply, and itincreases the heart rate. And
there are some situations wheresomeone's heart rate, if
they're exerting, would not goup, and that would make them
extremely fatigued. They're notable to do , uh, usual
activities that they are ableto do otherwise. So in those
(02:09):
scenarios, also, it can providea backup heart rate support.
Speaker 2 (02:12):
So I'm gonna talk a , uh, a little bit later in the
episode of some of the specificconditions that people have
that lead to that , um, thatcondition that you're
describing. Let's talk aboutthe pacemakers that people get.
So people have this idea ofwhat it is, but I don't know if
, if everybody knows exactlywhat it looks like and what it
does, could you give us just alittle walkthrough history, a
little bit of the history ofpacemakers? How, what did they
(02:35):
look like? How big were they,and where are they now?
Speaker 3 (02:37):
So there has been an evolution of , uh, over last
several decades , uh, withregards to pacemakers. And ,
uh, believe it or not , uh,Minnesota has a great history ,
uh, is part of that history. Infact, the first , uh, battery
operated pacemaker was , uh,invented , uh, here in , uh,
Minnesota. So they used to bereally big initially, you know,
(03:01):
external devices. In fact, theoriginal pacemaker was just ,
uh, transcutaneous , uh,pacing. And , uh, there was
like straps onto the chest,which again, in emergencies are
still used nowadays as pads.
Looks
Speaker 2 (03:16):
Like the electric chair, they had pads on your
chest and
Speaker 3 (03:18):
All that. That's right. And then they came up
with these , uh, wires , uh,which they could put directly
into the heart. The surgeonwould just put it onto the
heart muscle and connect it toa pulse generator on the
outside of the body. And theyused to be really big. And as
the time has evolved, the newerones are much smaller, much
(03:40):
smaller than your, your hand.
So they're much, much smaller.
They're lasting much longer.
Uh, the batteries on thepacemakers, they can last as
much as , uh, 10 to 15 years,kind
Speaker 2 (03:51):
Of a backwards way for me to get into medicine. I
remember that back in theeighties. I went into , uh,
engineering school because Iwanted to work on those things
like pacemakers and stuff. Iwas gonna be a biomedical
engineer. Well , that didn'twork out. And I , I settled for
being a , a medical doctorinstead. But the pacemaker was
one of the reasons I sort ofgot into this field. So you put
(04:11):
these things in all the time.
It's not the only thing you do,but you do also put pacemakers
in people. You're the guy thatdoes it. Could you talk us
through it? What do you, whatdo you do?
Speaker 3 (04:21):
Yes. So traditionally , uh, the
pacemaker, again, there aredifferent types of pacemakers,
which , uh, we may end uptalking about later. But , uh,
traditionally , uh, pacemakerprocedure includes , uh, it's a
small little battery operateddevice. And it has wires. Those
wires go inside , uh, insidethe heart. And essentially the
(04:43):
procedure takes less than anhour or maybe about an hour or
so. It's , uh, same dayprocedure. Usually patients
are, they can be completelyawake , uh, or sometimes we
give them a small dose ofmedication to make them a
little sleepy, just similar towhat , uh, if you go to a
dentist's office, they give yousome , uh, light sedation, but
(05:04):
the
Speaker 2 (05:04):
Dentist isn't putting wires into your heart.
Speaker 3 (05:08):
So , uh, it's, it's, it's amazing. Uh , and you
Speaker 2 (05:11):
Do it while they're awake?
Speaker 3 (05:13):
Yes, I have done it while , uh, they're , uh,
they're awake also, you know,we are chit-chatting and
talking to them. But again ,uh, for comfort, we do give ,
uh, some mild to moderatedegree of , uh, a sedative
drugs to make sure they're nothaving too much pain. So
essentially we give localanesthesia and the incision may
(05:33):
be about two to three fingerbreaths. And , uh, all they
feel is like pushing andtugging kind of sensation on
the skin. And we make a littlepocket under the skin. And, you
know, they say all roads leadto Rome, you know, all the
veins, they go to the heart. Sobasically you get access to a
(05:54):
large vein , uh, under thecollarbone usually. And , uh,
thread a couple of wires , uh,into the heart. And those wires
, uh, have a little screw atthe tip most of the times, and
we can just , uh, you
Speaker 2 (06:06):
Screw it in,
Speaker 3 (06:07):
Put it into the heart muscle.
Speaker 2 (06:08):
It does , and it stays
Speaker 3 (06:10):
And it usually stays, it usually
Speaker 2 (06:12):
Stay . Do , do you literally, like, okay, so
you're standing next to thisperson, you got this wire down
into their heart, you know,it's in there. Yes. Um , 'cause
you use a , an an X-ray thingto guide you. Yes. Do you
literally turn it, like screwit in?
Speaker 3 (06:23):
Yes, yes. Uh, there are different types of wires ,
uh, and some of them weactually have to, there's
little torque tool. We kind ofextend these screw out. Uh,
there are some wires whichactually have exposed screw,
and we just turn the whole wireinto the heart muscle. Wow.
Speaker 2 (06:39):
It's like a cork screw right into your heart
there. Exactly. Okay. So you'regoing in right under the
collarbone usually. And yousaid you put, you just put the
battery then under the skin?
Speaker 3 (06:47):
Yeah. So just connect the other end of the
wire to this , uh, what theycall pulse generator, which has
the , uh, electronic circuit inthere and the battery , uh,
together. And just connect thewire and put it on the skin .
Sew it up.
Speaker 2 (07:02):
I've seen you do it, actually. And it is , to me,
it's fascinating. It is like anhour procedure, so, so, right .
Do they ever need to bereplaced?
Speaker 3 (07:10):
Yes. So, you know, the batteries, as I mentioned
earlier , uh, nowadays,depending on of course, how
much somebody is using it up,if somebody is , uh, dependent
on the pacemaker a hundredpercent of the times versus
somebody's only using itintermittently still, most of
the times the batteries end upblasting more than 10 years.
(07:30):
Believe it or not. The longestbattery life that I've seen is
29 years. So yes, they need tobe replaced. If the battery is
going down, we then change itand take the old one out and
connect the wires to the newone. And the longest one I have
, uh, personally seen is, haslasted 29 years.
Speaker 2 (07:51):
You know , uh, my cell phone doesn't make it 29
hours., why don't theyput that battery in the cell
phone ? Does that make sense?
Am I right or am I right? Ithink they should put the
pacemaker battery in the cellphones .
Speaker 3 (08:01):
Yes . It's, it's very complicated because as
time passes by, we get more andmore demanding and there's more
and more data, right? So theolder versions of pacemakers,
they just had a simple functionto keep the heart at a minimum
rate that we program. The newerones, they have a lot of
additional functions. Theystore a lot of data. We
(08:22):
communicate , uh, with thesepacemakers more often. So the
battery usage is of coursemore, but still, I think 10 to
14 years is a pretty decenttimeframe. Wow . It's
Speaker 2 (08:32):
Basically a little computer in there. 'cause you
know, so you said youcommunicate with them? Yes .
What do you mean? Yes, is thistelepathy? telepathy.
Speaker 3 (08:40):
So essentially , uh, there's a little computer
programmer which communicateswith the pacemaker to tell us
how much battery is in there,how the wires are functioning,
has the person had any otherrhythm problems, it stores the
data. Uh, so it has a lot of ,uh, that information. Plus the
(09:01):
newer ones can also have somesort of , uh, communication
with , uh, via Bluetooth to ,to an app.
Speaker 2 (09:08):
Yeah . Bluetooth app. Can it play my favorite
songs ? That's what I want toknow.
Speaker 3 (09:11):
I don't think so.
Speaker 2 (09:13):
. Okay. Let,
let's shift now. What
conditions would , uh, causethe need for a pacemaker?
Speaker 3 (09:19):
Uh , a common indication is called complete
heart block. Now, in general,when people talk about
blockages in the heart, they'reusually talking about plumbing
system of the heart. You know,the arteries, when they get
blocked, people get stents andthe bypasses and that kind of
stuff. Uh, but here we aretalking about the electrical
(09:41):
block in the heart. So normallyheart has four chambers to top
and to bottom. And theelectrical impulse activates
the top chambers first. Thenthat message goes down to the
bottom chambers. So there aretimes when there can be a delay
or there can be , uh, adisconnect , uh, with that
(10:06):
connection between the top andthe bottom chamber. And the top
chamber wants the heart to beatat a certain rate, but the
message would not go through.
So in those scenarios, patientsdo benefit from a pacemaker. So
the ,
Speaker 2 (10:19):
The electrical circuit is blocked.
Speaker 3 (10:22):
Exactly. Do you put
Speaker 2 (10:23):
The lead then in the ventricles, the lower chamber?
Speaker 3 (10:26):
Yes. So the wires then are put in the top chamber
as well as in the bottomchamber. And essentially it
functions as a connectionbetween the top and the bottom,
that it communicates themessage to the bottom that,
hey, the top chamber has doneits job, now it's your turn.
And that's in simplistic , uh,ways , if you can put it. There
(10:47):
are other reasons where , uh,someone may need a pacemaker.
As I mentioned, their heartrate may not have enough
adequate response to exertion,so they can feel fatigued,
extremely tired. Now, there aremany other reasons people can
get tired, but one of thosereasons is if the heart rate
does not increase appropriatelyin those scenarios, it's just
(11:08):
too slow. It's just too slow.
Speaker 2 (11:10):
Are there other conditions we've talked about
heart block, bradycardia,although we haven't used that
term. That's the slow heartrate. Yes . Anything else that
you put pacemakers in?
Speaker 3 (11:17):
Yes. So you might have heard of a condition
called atrial fibrillation. Inthose scenarios , uh, the heart
rate tends to go fast at sometimes , but there are some
scenarios where the heart ratecan also get slow. So now you
are in a bind that, well, if Itreat the fast heart rate with
a medication that's gonna slowit down, the heart may slow
(11:39):
down really low. Uh, at otheroccasion in those scenarios,
again, preemptively, sometimeswe end up putting a pacemaker
in.
Speaker 2 (11:47):
I'm hoping you'll come back for a future episode.
'cause I would love to delveinto atrial fibrillation.
Speaker 3 (11:52):
Yeah, happy to.
Yeah,
Speaker 2 (11:53):
We'll have, we'll have Dr. Kareem back to talk
about that topic, which is, Ithink, the most common
arrhythmia , uh, like in theworld. So to sum up the
conditions, it's variousarrhythmias of the heart and
arrhythmia is just a , ainappropriate rhythm, like
heart block, bradycardia, tooslow of heart, things like
that. Sometimes in atrialfibrillation.
Speaker 3 (12:11):
Yes, yes.
Speaker 2 (12:12):
Excellent. So I think we've earned a break. Uh,
listeners, when we come back,I'm gonna ask Dr. Kareem to
talk a little bit about thestatistics and impact of
pacemakers worldwide. And thenwe're gonna talk a little bit
about future directions in theelectricity of your heart.
We'll be right back
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(12:53):
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Speaker 2 (13:09):
And we're back. I'm talking with Dr. Rehan Kareem .
He is an electrophysiologist,which is the, a cardiologist
who is the electrician of yourheart, not the plumber, the
electrician. Did you ever thinkyou'd be an electrician? Rehan
? That's what you are. I'veheard you describe yourself as
that.
Speaker 3 (13:22):
Yeah, that's, that's a good question. I, I had
always wanted to go intoelectrophysiology. It was my
passion.
Speaker 2 (13:29):
It's actually a fascinating , um, subspecialty
of cardiology. We've beentalking about pacemakers, some
of the reasons people get themand , and kind of the basics of
what they are and what they do.
Let's talk a little bit aboutthe global impact of
pacemakers. Do you have a sensefor how commonly people have to
have them place? I don't expectyou to know the exact number,
but roughly ,
Speaker 3 (13:49):
Uh , in general, it is felt that , uh, in general
population around 260, out of100,000 people have pacemakers.
But again, the prevalencevaries by age. So if you have
younger folks, between 18 to65, 40 out of 100,000 would
have it. But if you look at theolder population, more than 75
(14:12):
years of age, actually almost2,500 plus out of a hundred
thousand , uh, people may endup , uh, having pacemakers.
Speaker 2 (14:21):
So it's clearly a a you're more commonly doing it
in older adults.
Speaker 3 (14:26):
Yes, that is correct. You know, you can
think of it this way that astime passes by, the electrical
wiring tends to get worn outand may need some extra
support. Oh,
Speaker 2 (14:35):
That's a great way to look at it. Kinda like my
house, which will probably burndown one day from all the old
electron , the , the faultywiring, if you will. So men and
women, both generally olderpeople. Yes. Talk us through a
little, if you could then aboutthe pros and cons, how
successful it is in putting init , and, and even like, what
are some of the risks when youdo it?
Speaker 3 (14:54):
So as far as the success of putting in a
pacemaker is concerned, it isin general considered a
relatively straightforwardprocedure, and it's done very
commonly throughout the world.
So from that perspective, theimmediate success rates are
fairly high. It's, it's very,very uncommon that anyone who's
(15:17):
wanting to have a pacemaker putin and they are unsuccessful in
putting in a pacemaker. It's ,it's very, it's extremely rare,
but certainly it is an invasiveprocedure. So as with any
invasive procedure, there arerisks involved, and that's why
, uh, risks and benefit comeinto play. So anyone who comes
in there , my heart rate isslow. I want a pacemaker, and
(15:41):
we don't put it in like that,right? We have to make sure
that it's actually going tomake any difference in that
person's life and in symptoms.
So risks involve risk ofinfection , uh, again , uh, as
the time has passed by steriletechniques and , uh, more focus
on cleanliness , uh, of theprocedure itself and the
(16:02):
operating rooms, the risk ofinfections are fairly low, but
they're not zero , uh, risk ofany damage to the tissue where
you're putting it in , uh,damage to the blood vessels or
the nerves, any bleeding. Nowwe are putting these wires
inside the heart, which have alittle screw on them. So
(16:23):
there's always a rare chance ofpoking a hole , uh, in the
heart, causing a littlebleeding around may require a
little drainage. Butfortunately, it is extremely
rare. Now, when we put thesewires in, there can be slight
risk that it can get dislodgedor moved from its place. And
that's why after putting 'emin, we usually warn patients to
(16:47):
just keep the arm the sling fora few days and not to move it
aggressively , uh, for somedays because until the wire
settles in place, it can getmoved , you know, dislodged
from its place where we mayhave to go back and unscrew and
ew a different ,
Speaker 2 (17:02):
Different place .
Can I, I dig into that a littlebit more. So you, you have
somebody to keep your arm byyour side, put it in a sling,
and , and I, is it true they'renot supposed to raise their
arms above their heads and dopull-ups or serve a tennis ball
or something like that? Yeah,
Speaker 3 (17:14):
For a short period of time until it heals in
place. After that, usuallythey're able to resume most of
their routine activities.
Speaker 2 (17:24):
What about what it feels like? So obviously, you
know, there's a , you hadsomething cut and put into your
skin, so you know, you have alittle discomfort at the place
of that, like you wouldwhenever your skin gets cut.
Beyond that though, afterthose, that first week or two,
do people even know they havethem ? Is it uncomfortable in
any way, shape, or form?
Speaker 3 (17:41):
So most people don't even feel afterwards , uh,
other than little pump thereand a scar,
Speaker 2 (17:48):
You can often feel it. Yeah , I feel it all the
time. On patients in your leftupper chest, usually, yeah .
Speaker 3 (17:52):
Yes. But you know, as with any wound healing,
every person heals differently.
And there are rarecircumstances where someone may
have severe incisional pain orthey may have scar bigger than
usual. Some people tend to formkeloids, some people may have
(18:13):
some burning sensation at thescar for a longer period of
time, but that's very, veryrare. And that, again, as I
said, everyone heals , uh, in adifferent manner. But for the
most part, most people don'tfeel this. One other question
that comes up is , uh, youknow, do I feel shocking
sensation with this pacemaker?
(18:34):
Again, most of the times peopledon't feel any such sensation.
There's a nerve that goes nextto the heart. It helps us
breathe. It's called phrenicnerve. It goes to the
diaphragm. And there can be arare circumstance where the
wire can be closed to that andit can stimulate that nerve
(18:55):
resulting in hiccup type ofsensation. Now, when we put it
in, we specifically test for itto make sure that it is,
Speaker 2 (19:02):
You put it in there, you tickle their heart and see
if they hiccup. Uh ,
Speaker 3 (19:05):
Yes, we do, we actually do stimulate at a high
output to make sure it is notclose to the, to the nerve. I
did that before , before wefixated in , in , in place. So
Speaker 2 (19:16):
After they've had it placed, are there any risks
with things like being extramicrowave or going through
airport security or metaldetectors? What about that?
Speaker 3 (19:25):
Yeah, the newer devices are really smart. So
microwaves are not an issueunless you don't microwave
yourself. But , uh, right ,
Speaker 2 (19:33):
Right , right . But you can, you can cook your
oatmeal on your ,
Speaker 3 (19:36):
You can cook your oatmeal. That is , uh, that is
not a problem As far as , uh,going through metal detectors
is concerned, the patients doget an identification card
saying the model number thatthey have a pacemaker or a
defibrillator, whatever,implantable device. So when
they go through airportsecurity, they have to show and
tell them that they have animplantable device. In general,
(19:57):
most of the times it is okay,but just for certain safety
reasons, it is always better tomention it to them and they go
through a manual search.
Speaker 2 (20:08):
What about an MRI?
Because an MRI uses a magnet.
This thing's metal, it's gotmetal wires. What about using,
historically we haven't allowedpeople with pacemakers to have
an MRI .
Speaker 3 (20:18):
Has that changed ?
That is correct. The olderdevices, that was a concern.
The newer devices , uh, have a, a specific FDA labeling
called MRI conditional. Theseare MRI . Conditional means if
they meet certain conditions,those patients can have MRI at
a certain power level of theMRI . So they need to be
(20:39):
reprogrammed , uh, and they canget the MRIs done. Let's talk
Speaker 2 (20:43):
About the future. So where do you see future
developments in pacemakertechnology?
Speaker 3 (20:48):
Well, a lot of things have changed actually
over last , uh, several years.
Most recently, the advent ofleadless pacemakers. So, you
know, we talked about thesewires, they're relatively easy
to put in, but taking them outagain involves a different set
of risks. Uh , if someone getsinfected for whatever reason,
(21:10):
it is a bigger deal to havethem taken out. So over last
several years, they have comeup with leadless pacemakers. So
it's just looks literally likea bullet and it gets directly
implanted into the heartwithout a wire in place. So
they don't have any incision onthe chest. It just goes
directly through a , a vein inthe leg, and through that, it
(21:33):
gets directly implanted intothe right ventricle.
Speaker 2 (21:35):
Okay. I gotta ask into the right , I was gonna
ask where , where doyou bury this thing in the
right ventricle? That's not avery thick part of the heart.
Speaker 3 (21:43):
Yes, it is not a very thick part of the heart.
Speaker 2 (21:45):
The left side's the thick, beefy
Speaker 3 (21:47):
Part. That is correct. And that's why when we
put it in, we have to make surethat it is onto the wall in
between the right and the leftside. It cannot be on the free
area because that's pretty thin
Speaker 2 (21:58):
Wall. It has to be the wall between the two
ventricles. That isfascinating. Is that ready for
primetime? Are people usingthat or is that a down the road
kind of a thing?
Speaker 3 (22:05):
That has been out , uh, out and about for several
years now.
Speaker 2 (22:09):
Wow. I don't even think I was terribly aware of
that one. So you do this andprobably could do it in your
sleep, putting wires andpacemakers in. And so for you
it's never a big deal, but itis for the patients.
Everything's always a big dealfor the patients. I tell
patients that all the time.
They , they say, is this arisky thing? And or , and I
said , the cardiologist, it'sroutine, but I know it's not
(22:29):
for you. But that being said,you are putting wires in people
and this pulse generator, whywouldn't everybody want this
leadless model?
Speaker 3 (22:37):
That's, that's a good question. That certainly
is a possibility that anyonecan get a leadless pacemaker.
However, right now the way itis being done is that, let's
say when the battery goes down,then you have to put a new one
in. So then heart gets filled,
Speaker 2 (22:53):
Filling up the heart with little metal little
Speaker 3 (22:55):
Metals. Yes. When you asked earlier about the
future directions, one otherdevelopment that has , uh,
happened and is really pickingup a lot of his steam is , uh,
what they call conductionsystem pacing. So when we put
these wires in the heart, wedon't randomly put it anywhere
in the heart muscle, but weactually put it just onto or
(23:19):
next to the normal electricalwiring of the heart. So you can
think of it that the heart haselectrical wiring, and the way
it is made is the whole heartcan beat in an effective
manner. Now, when weartificially stimulate the
heart from just anywhere, itmay not be as effective of a
(23:41):
synchrony, if you were to say.
So the newer ones, we put thewire specifically next to the
normal wiring of the heart. Sothat is getting more and more
popular, and we are doing moreand more of those types of
devices. So the pacemaker isthe same, but the wire is
slightly different, and theplace where it goes requires a
(24:03):
little more precision aboutwhere exactly you wanna put in
. And that has been shown to bemore beneficial.
Speaker 2 (24:09):
That's super cool.
That's super cool. Many peoplehave heard of ICDs, implantable
cardioverter defibrillators.
We've been talking aboutpacemakers that deal with
arrhythmias of the heart, slowheart rates, complete heart
rock . We're not gonna gettotally into all the reasons
for an ICD , but it's also adevice that's implanted with
wires in your heart. Could yougive us just a little bit of a
(24:30):
comparison of what thedifference between those
devices is ?
Speaker 3 (24:32):
Yes, absolutely. So as I mentioned earlier, the
sole purpose of a pacemaker isto prevent a slow heart rate or
to treat a slow heart rate. Thepurpose of a defibrillator is
to treat a very rapid heartrate, which could result in a
cardiac arrest. So you canthink of it two extremes. Very
slow heart rate is treated by apacemaker, but the purpose of a
(24:56):
defibrillator is purely toshock the heart, or in certain
scenarios, treat that rapidheartbeat just by a pacemaker
function. But essentially, thepure purpose of the
defibrillator, or ICD , is totreat a very rapid heartbeat or
a cardiac arrest.
Speaker 2 (25:12):
It's like an insurance policy against sudden
cardiac death. Really,
Speaker 3 (25:15):
You can think of it that
Speaker 2 (25:16):
Yeah, that's kind of the clumsy, you know, high
level weight . And we're we'll, uh, perhaps get Dr uh ,
Kareem on the show in thefuture to talk about that too.
There's a lot of conditions ,uh, involving the electrical
conducting system of yourheart. The heart is
fascinating. It just isfascinating. It's, first of
all, a chemical reaction thatthen leads to an electrical
current, which then leads to amechanical pump. It's an
(25:36):
engineer's dream, actually . All the engineers ,
uh, out there listening theirheart , it has, has a
mechanical and electrical and achemical all put together.
Before I let you go, Dr. Kareem, if you could give three tips
to our listeners when they'rethinking about pacemakers in
their heart, what would youlike them to remember?
Speaker 3 (25:52):
The first and the foremost thing is that the
pacemakers are there to treatyour symptoms. So just do not
go after a number of the heartrate. My heart rate is this
slow. Now I'm gonna feel bad ifsomeone is having symptoms with
that slow heart rate, that iswhat pacemaker is supposed to
do. So that's first thing tokeep in mind. The second thing
(26:16):
is, if needed, they can reallymake a big difference to
someone's life and people canlead as normal of a life as
possible with these pacemakers.
Uh, the third thing is thereare a lot of resources , uh,
which are available if thereare any questions. And the one
that I would , uh, recommendstrongly is Heart Rhythm
(26:39):
Society is a , a NationalSociety for Heart Rhythm
Disorders, and it has a lot ofresources. And there is a
website for patients , uh,specifically it's called
upbeat.org, U-P-B-E-A-T uh ,dot org. It has , uh, a lot of
information about heart rhythmdisorders in general. So
Speaker 2 (27:01):
We can put a link in our show notes to the
upbeat.org at the Heart RhythmSociety. If you wanna learn
more about your heart, I'vebeen talking to Dr. Rahan ,
Kareem Electrophysiologist hereat Hennepin Healthcare and a
colleague of mine. I am notexaggerating listeners. I am
not exaggerating when I saythat if I needed an electrical
procedure done on my heart orone of my loved ones, it is Dr.
(27:22):
Kareem that I would send themto. He is as good as they come.
And I just want to thank youfor being on the episode
Speaker 3 (27:27):
Today. Well , thank you so much, David, for having
me here, and you're toogenerous.
Speaker 2 (27:31):
No, I'm not. Thank you . He is truly the best
electrophysiologist I know.
Thanks for listening to episode11 of the podcast. We have
another one coming up in twoweeks, and I hope you'll join
us. And in the meantime, behealthy and be well.
Speaker 1 (27:44):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:06):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:27):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden.
Speaker 2 (00:19):
Hey everybody. Dr.
David Hilden here, and welcometo episode 11 of the podcast.
Today we're gonna talk to Dr.
Rahan Kareem. He is anelectrophysiologist. What's
that you say? Well, he's acardiologist who specializes in
the electrical systems of yourheart. Dr. Kareem , thanks for
being here.
Speaker 3 (00:34):
Thank you for having me here. It's
Speaker 2 (00:35):
Great to have you here. And I'd like to focus
today on pacemakers. Uh, I knowyou do a lot in your job, and
we'll maybe get you back on afuture episode to talk about
other things, but today I wannatalk about pacemakers and what
do they do and why are theyused, things like that. So,
could you start us off and tellus what's the function of a
pacemaker?
Speaker 3 (00:53):
First of all, thank you again for having me here.
In simplistic terms, the onlyjob of a pacemaker is to
prevent the heart from goingtoo slow. For whatever reason,
heart rate is going very slow.
That is making someonesymptomatic. Then the job of
the pacemaker is to make surethat there is a minimum heart
(01:16):
rate that it provides.
Speaker 2 (01:17):
So it sets the pace.
Yes. So what's the problem? Ifsomeone's heart's going too
slow?
Speaker 3 (01:22):
They could have a lot of problems. The main
complaint , uh, people canpresent with is feeling dizzy
or lightheaded. Or if heartdecides not to beat for a few
seconds, a person can actuallypass out and injure themselves.
They can feel fatigued. Anormal person, if they start
running or the physicalactivity goes up the heart, the
(01:46):
human body , uh, has an amazingway that it can sense that body
needs more blood supply, and itincreases the heart rate. And
there are some situations wheresomeone's heart rate, if
they're exerting, would not goup, and that would make them
extremely fatigued. They're notable to do , uh, usual
activities that they are ableto do otherwise. So in those
(02:09):
scenarios, also, it can providea backup heart rate support.
Speaker 2 (02:12):
So I'm gonna talk a , uh, a little bit later in the
episode of some of the specificconditions that people have
that lead to that , um, thatcondition that you're
describing. Let's talk aboutthe pacemakers that people get.
So people have this idea ofwhat it is, but I don't know if
, if everybody knows exactlywhat it looks like and what it
does, could you give us just alittle walkthrough history, a
little bit of the history ofpacemakers? How, what did they
(02:35):
look like? How big were they,and where are they now?
Speaker 3 (02:37):
So there has been an evolution of , uh, over last
several decades , uh, withregards to pacemakers. And ,
uh, believe it or not , uh,Minnesota has a great history ,
uh, is part of that history. Infact, the first , uh, battery
operated pacemaker was , uh,invented , uh, here in , uh,
Minnesota. So they used to bereally big initially, you know,
(03:01):
external devices. In fact, theoriginal pacemaker was just ,
uh, transcutaneous , uh,pacing. And , uh, there was
like straps onto the chest,which again, in emergencies are
still used nowadays as pads.
Looks
Speaker 2 (03:16):
Like the electric chair, they had pads on your
chest and
Speaker 3 (03:18):
All that. That's right. And then they came up
with these , uh, wires , uh,which they could put directly
into the heart. The surgeonwould just put it onto the
heart muscle and connect it toa pulse generator on the
outside of the body. And theyused to be really big. And as
the time has evolved, the newerones are much smaller, much
(03:40):
smaller than your, your hand.
So they're much, much smaller.
They're lasting much longer.
Uh, the batteries on thepacemakers, they can last as
much as , uh, 10 to 15 years,kind
Speaker 2 (03:51):
Of a backwards way for me to get into medicine. I
remember that back in theeighties. I went into , uh,
engineering school because Iwanted to work on those things
like pacemakers and stuff. Iwas gonna be a biomedical
engineer. Well , that didn'twork out. And I , I settled for
being a , a medical doctorinstead. But the pacemaker was
one of the reasons I sort ofgot into this field. So you put
(04:11):
these things in all the time.
It's not the only thing you do,but you do also put pacemakers
in people. You're the guy thatdoes it. Could you talk us
through it? What do you, whatdo you do?
Speaker 3 (04:21):
Yes. So traditionally , uh, the
pacemaker, again, there aredifferent types of pacemakers,
which , uh, we may end uptalking about later. But , uh,
traditionally , uh, pacemakerprocedure includes , uh, it's a
small little battery operateddevice. And it has wires. Those
wires go inside , uh, insidethe heart. And essentially the
(04:43):
procedure takes less than anhour or maybe about an hour or
so. It's , uh, same dayprocedure. Usually patients
are, they can be completelyawake , uh, or sometimes we
give them a small dose ofmedication to make them a
little sleepy, just similar towhat , uh, if you go to a
dentist's office, they give yousome , uh, light sedation, but
(05:04):
the
Speaker 2 (05:04):
Dentist isn't putting wires into your heart.
Speaker 3 (05:08):
So , uh, it's, it's, it's amazing. Uh , and you
Speaker 2 (05:11):
Do it while they're awake?
Speaker 3 (05:13):
Yes, I have done it while , uh, they're , uh,
they're awake also, you know,we are chit-chatting and
talking to them. But again ,uh, for comfort, we do give ,
uh, some mild to moderatedegree of , uh, a sedative
drugs to make sure they're nothaving too much pain. So
essentially we give localanesthesia and the incision may
(05:33):
be about two to three fingerbreaths. And , uh, all they
feel is like pushing andtugging kind of sensation on
the skin. And we make a littlepocket under the skin. And, you
know, they say all roads leadto Rome, you know, all the
veins, they go to the heart. Sobasically you get access to a
(05:54):
large vein , uh, under thecollarbone usually. And , uh,
thread a couple of wires , uh,into the heart. And those wires
, uh, have a little screw atthe tip most of the times, and
we can just , uh, you
Speaker 2 (06:06):
Screw it in,
Speaker 3 (06:07):
Put it into the heart muscle.
Speaker 2 (06:08):
It does , and it stays
Speaker 3 (06:10):
And it usually stays, it usually
Speaker 2 (06:12):
Stay . Do , do you literally, like, okay, so
you're standing next to thisperson, you got this wire down
into their heart, you know,it's in there. Yes. Um , 'cause
you use a , an an X-ray thingto guide you. Yes. Do you
literally turn it, like screwit in?
Speaker 3 (06:23):
Yes, yes. Uh, there are different types of wires ,
uh, and some of them weactually have to, there's
little torque tool. We kind ofextend these screw out. Uh,
there are some wires whichactually have exposed screw,
and we just turn the whole wireinto the heart muscle. Wow.
Speaker 2 (06:39):
It's like a cork screw right into your heart
there. Exactly. Okay. So you'regoing in right under the
collarbone usually. And yousaid you put, you just put the
battery then under the skin?
Speaker 3 (06:47):
Yeah. So just connect the other end of the
wire to this , uh, what theycall pulse generator, which has
the , uh, electronic circuit inthere and the battery , uh,
together. And just connect thewire and put it on the skin .
Sew it up.
Speaker 2 (07:02):
I've seen you do it, actually. And it is , to me,
it's fascinating. It is like anhour procedure, so, so, right .
Do they ever need to bereplaced?
Speaker 3 (07:10):
Yes. So, you know, the batteries, as I mentioned
earlier , uh, nowadays,depending on of course, how
much somebody is using it up,if somebody is , uh, dependent
on the pacemaker a hundredpercent of the times versus
somebody's only using itintermittently still, most of
the times the batteries end upblasting more than 10 years.
(07:30):
Believe it or not. The longestbattery life that I've seen is
29 years. So yes, they need tobe replaced. If the battery is
going down, we then change itand take the old one out and
connect the wires to the newone. And the longest one I have
, uh, personally seen is, haslasted 29 years.
Speaker 2 (07:51):
You know , uh, my cell phone doesn't make it 29
hours.
phone ? Does that make sense?
Am I right or am I right? Ithink they should put the
pacemaker battery in the cellphones .
Speaker 3 (08:01):
Yes . It's, it's very complicated because as
time passes by, we get more andmore demanding and there's more
and more data, right? So theolder versions of pacemakers,
they just had a simple functionto keep the heart at a minimum
rate that we program. The newerones, they have a lot of
additional functions. Theystore a lot of data. We
(08:22):
communicate , uh, with thesepacemakers more often. So the
battery usage is of coursemore, but still, I think 10 to
14 years is a pretty decenttimeframe. Wow . It's
Speaker 2 (08:32):
Basically a little computer in there. 'cause you
know, so you said youcommunicate with them? Yes .
What do you mean? Yes, is thistelepathy?
Speaker 3 (08:40):
So essentially , uh, there's a little computer
programmer which communicateswith the pacemaker to tell us
how much battery is in there,how the wires are functioning,
has the person had any otherrhythm problems, it stores the
data. Uh, so it has a lot of ,uh, that information. Plus the
(09:01):
newer ones can also have somesort of , uh, communication
with , uh, via Bluetooth to ,to an app.
Speaker 2 (09:08):
Yeah . Bluetooth app. Can it play my favorite
songs ? That's what I want toknow.
Speaker 3 (09:11):
I don't think so.
Speaker 2 (09:13):
conditions would , uh, causethe need for a pacemaker?
Speaker 3 (09:19):
Uh , a common indication is called complete
heart block. Now, in general,when people talk about
blockages in the heart, they'reusually talking about plumbing
system of the heart. You know,the arteries, when they get
blocked, people get stents andthe bypasses and that kind of
stuff. Uh, but here we aretalking about the electrical
(09:41):
block in the heart. So normallyheart has four chambers to top
and to bottom. And theelectrical impulse activates
the top chambers first. Thenthat message goes down to the
bottom chambers. So there aretimes when there can be a delay
or there can be , uh, adisconnect , uh, with that
(10:06):
connection between the top andthe bottom chamber. And the top
chamber wants the heart to beatat a certain rate, but the
message would not go through.
So in those scenarios, patientsdo benefit from a pacemaker. So
the ,
Speaker 2 (10:19):
The electrical circuit is blocked.
Speaker 3 (10:22):
Exactly. Do you put
Speaker 2 (10:23):
The lead then in the ventricles, the lower chamber?
Speaker 3 (10:26):
Yes. So the wires then are put in the top chamber
as well as in the bottomchamber. And essentially it
functions as a connectionbetween the top and the bottom,
that it communicates themessage to the bottom that,
hey, the top chamber has doneits job, now it's your turn.
And that's in simplistic , uh,ways , if you can put it. There
(10:47):
are other reasons where , uh,someone may need a pacemaker.
As I mentioned, their heartrate may not have enough
adequate response to exertion,so they can feel fatigued,
extremely tired. Now, there aremany other reasons people can
get tired, but one of thosereasons is if the heart rate
does not increase appropriatelyin those scenarios, it's just
(11:08):
too slow. It's just too slow.
Speaker 2 (11:10):
Are there other conditions we've talked about
heart block, bradycardia,although we haven't used that
term. That's the slow heartrate. Yes . Anything else that
you put pacemakers in?
Speaker 3 (11:17):
Yes. So you might have heard of a condition
called atrial fibrillation. Inthose scenarios , uh, the heart
rate tends to go fast at sometimes , but there are some
scenarios where the heart ratecan also get slow. So now you
are in a bind that, well, if Itreat the fast heart rate with
a medication that's gonna slowit down, the heart may slow
(11:39):
down really low. Uh, at otheroccasion in those scenarios,
again, preemptively, sometimeswe end up putting a pacemaker
in.
Speaker 2 (11:47):
I'm hoping you'll come back for a future episode.
'cause I would love to delveinto atrial fibrillation.
Speaker 3 (11:52):
Yeah, happy to.
Yeah,
Speaker 2 (11:53):
We'll have, we'll have Dr. Kareem back to talk
about that topic, which is, Ithink, the most common
arrhythmia , uh, like in theworld. So to sum up the
conditions, it's variousarrhythmias of the heart and
arrhythmia is just a , ainappropriate rhythm, like
heart block, bradycardia, tooslow of heart, things like
that. Sometimes in atrialfibrillation.
Speaker 3 (12:11):
Yes, yes.
Speaker 2 (12:12):
Excellent. So I think we've earned a break. Uh,
listeners, when we come back,I'm gonna ask Dr. Kareem to
talk a little bit about thestatistics and impact of
pacemakers worldwide. And thenwe're gonna talk a little bit
about future directions in theelectricity of your heart.
We'll be right back
Speaker 4 (12:31):
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for life. They mean here foryou, your life, and all that it
brings. Hennepin Healthcare hasa hospital, HCMC, and a network
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expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(12:53):
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Speaker 2 (13:09):
And we're back. I'm talking with Dr. Rehan Kareem .
He is an electrophysiologist,which is the, a cardiologist
who is the electrician of yourheart, not the plumber, the
electrician. Did you ever thinkyou'd be an electrician? Rehan
? That's what you are. I'veheard you describe yourself as
that.
Speaker 3 (13:22):
Yeah, that's, that's a good question. I, I had
always wanted to go intoelectrophysiology. It was my
passion.
Speaker 2 (13:29):
It's actually a fascinating , um, subspecialty
of cardiology. We've beentalking about pacemakers, some
of the reasons people get themand , and kind of the basics of
what they are and what they do.
Let's talk a little bit aboutthe global impact of
pacemakers. Do you have a sensefor how commonly people have to
have them place? I don't expectyou to know the exact number,
but roughly ,
Speaker 3 (13:49):
Uh , in general, it is felt that , uh, in general
population around 260, out of100,000 people have pacemakers.
But again, the prevalencevaries by age. So if you have
younger folks, between 18 to65, 40 out of 100,000 would
have it. But if you look at theolder population, more than 75
(14:12):
years of age, actually almost2,500 plus out of a hundred
thousand , uh, people may endup , uh, having pacemakers.
Speaker 2 (14:21):
So it's clearly a a you're more commonly doing it
in older adults.
Speaker 3 (14:26):
Yes, that is correct. You know, you can
think of it this way that astime passes by, the electrical
wiring tends to get worn outand may need some extra
support. Oh,
Speaker 2 (14:35):
That's a great way to look at it. Kinda like my
house, which will probably burndown one day from all the old
electron , the , the faultywiring, if you will. So men and
women, both generally olderpeople. Yes. Talk us through a
little, if you could then aboutthe pros and cons, how
successful it is in putting init , and, and even like, what
are some of the risks when youdo it?
Speaker 3 (14:54):
So as far as the success of putting in a
pacemaker is concerned, it isin general considered a
relatively straightforwardprocedure, and it's done very
commonly throughout the world.
So from that perspective, theimmediate success rates are
fairly high. It's, it's very,very uncommon that anyone who's
(15:17):
wanting to have a pacemaker putin and they are unsuccessful in
putting in a pacemaker. It's ,it's very, it's extremely rare,
but certainly it is an invasiveprocedure. So as with any
invasive procedure, there arerisks involved, and that's why
, uh, risks and benefit comeinto play. So anyone who comes
in there , my heart rate isslow. I want a pacemaker, and
(15:41):
we don't put it in like that,right? We have to make sure
that it's actually going tomake any difference in that
person's life and in symptoms.
So risks involve risk ofinfection , uh, again , uh, as
the time has passed by steriletechniques and , uh, more focus
on cleanliness , uh, of theprocedure itself and the
(16:02):
operating rooms, the risk ofinfections are fairly low, but
they're not zero , uh, risk ofany damage to the tissue where
you're putting it in , uh,damage to the blood vessels or
the nerves, any bleeding. Nowwe are putting these wires
inside the heart, which have alittle screw on them. So
(16:23):
there's always a rare chance ofpoking a hole , uh, in the
heart, causing a littlebleeding around may require a
little drainage. Butfortunately, it is extremely
rare. Now, when we put thesewires in, there can be slight
risk that it can get dislodgedor moved from its place. And
that's why after putting 'emin, we usually warn patients to
(16:47):
just keep the arm the sling fora few days and not to move it
aggressively , uh, for somedays because until the wire
settles in place, it can getmoved , you know, dislodged
from its place where we mayhave to go back and unscrew and
ew a different ,
Speaker 2 (17:02):
Different place .
Can I, I dig into that a littlebit more. So you, you have
somebody to keep your arm byyour side, put it in a sling,
and , and I, is it true they'renot supposed to raise their
arms above their heads and dopull-ups or serve a tennis ball
or something like that? Yeah,
Speaker 3 (17:14):
For a short period of time until it heals in
place. After that, usuallythey're able to resume most of
their routine activities.
Speaker 2 (17:24):
What about what it feels like? So obviously, you
know, there's a , you hadsomething cut and put into your
skin, so you know, you have alittle discomfort at the place
of that, like you wouldwhenever your skin gets cut.
Beyond that though, afterthose, that first week or two,
do people even know they havethem ? Is it uncomfortable in
any way, shape, or form?
Speaker 3 (17:41):
So most people don't even feel afterwards , uh,
other than little pump thereand a scar,
Speaker 2 (17:48):
You can often feel it. Yeah , I feel it all the
time. On patients in your leftupper chest, usually, yeah .
Speaker 3 (17:52):
Yes. But you know, as with any wound healing,
every person heals differently.
And there are rarecircumstances where someone may
have severe incisional pain orthey may have scar bigger than
usual. Some people tend to formkeloids, some people may have
(18:13):
some burning sensation at thescar for a longer period of
time, but that's very, veryrare. And that, again, as I
said, everyone heals , uh, in adifferent manner. But for the
most part, most people don'tfeel this. One other question
that comes up is , uh, youknow, do I feel shocking
sensation with this pacemaker?
(18:34):
Again, most of the times peopledon't feel any such sensation.
There's a nerve that goes nextto the heart. It helps us
breathe. It's called phrenicnerve. It goes to the
diaphragm. And there can be arare circumstance where the
wire can be closed to that andit can stimulate that nerve
(18:55):
resulting in hiccup type ofsensation. Now, when we put it
in, we specifically test for itto make sure that it is,
Speaker 2 (19:02):
You put it in there, you tickle their heart and see
if they hiccup. Uh ,
Speaker 3 (19:05):
Yes, we do, we actually do stimulate at a high
output to make sure it is notclose to the, to the nerve. I
did that before , before wefixated in , in , in place. So
Speaker 2 (19:16):
After they've had it placed, are there any risks
with things like being extramicrowave or going through
airport security or metaldetectors? What about that?
Speaker 3 (19:25):
Yeah, the newer devices are really smart. So
microwaves are not an issueunless you don't microwave
yourself. But , uh, right ,
Speaker 2 (19:33):
Right , right . But you can, you can cook your
oatmeal on your ,
Speaker 3 (19:36):
You can cook your oatmeal. That is , uh, that is
not a problem As far as , uh,going through metal detectors
is concerned, the patients doget an identification card
saying the model number thatthey have a pacemaker or a
defibrillator, whatever,implantable device. So when
they go through airportsecurity, they have to show and
tell them that they have animplantable device. In general,
(19:57):
most of the times it is okay,but just for certain safety
reasons, it is always better tomention it to them and they go
through a manual search.
Speaker 2 (20:08):
What about an MRI?
Because an MRI uses a magnet.
This thing's metal, it's gotmetal wires. What about using,
historically we haven't allowedpeople with pacemakers to have
an MRI .
Speaker 3 (20:18):
Has that changed ?
That is correct. The olderdevices, that was a concern.
The newer devices , uh, have a, a specific FDA labeling
called MRI conditional. Theseare MRI . Conditional means if
they meet certain conditions,those patients can have MRI at
a certain power level of theMRI . So they need to be
(20:39):
reprogrammed , uh, and they canget the MRIs done. Let's talk
Speaker 2 (20:43):
About the future. So where do you see future
developments in pacemakertechnology?
Speaker 3 (20:48):
Well, a lot of things have changed actually
over last , uh, several years.
Most recently, the advent ofleadless pacemakers. So, you
know, we talked about thesewires, they're relatively easy
to put in, but taking them outagain involves a different set
of risks. Uh , if someone getsinfected for whatever reason,
(21:10):
it is a bigger deal to havethem taken out. So over last
several years, they have comeup with leadless pacemakers. So
it's just looks literally likea bullet and it gets directly
implanted into the heartwithout a wire in place. So
they don't have any incision onthe chest. It just goes
directly through a , a vein inthe leg, and through that, it
(21:33):
gets directly implanted intothe right ventricle.
Speaker 2 (21:35):
Okay. I gotta ask into the right , I was gonna
ask where
right ventricle? That's not avery thick part of the heart.
Speaker 3 (21:43):
Yes, it is not a very thick part of the heart.
Speaker 2 (21:45):
The left side's the thick, beefy
Speaker 3 (21:47):
Part. That is correct. And that's why when we
put it in, we have to make surethat it is onto the wall in
between the right and the leftside. It cannot be on the free
area because that's pretty thin
Speaker 2 (21:58):
Wall. It has to be the wall between the two
ventricles. That isfascinating. Is that ready for
primetime? Are people usingthat or is that a down the road
kind of a thing?
Speaker 3 (22:05):
That has been out , uh, out and about for several
years now.
Speaker 2 (22:09):
Wow. I don't even think I was terribly aware of
that one. So you do this andprobably could do it in your
sleep, putting wires andpacemakers in. And so for you
it's never a big deal, but itis for the patients.
Everything's always a big dealfor the patients. I tell
patients that all the time.
They , they say, is this arisky thing? And or , and I
said , the cardiologist, it'sroutine, but I know it's not
(22:29):
for you. But that being said,you are putting wires in people
and this pulse generator, whywouldn't everybody want this
leadless model?
Speaker 3 (22:37):
That's, that's a good question. That certainly
is a possibility that anyonecan get a leadless pacemaker.
However, right now the way itis being done is that, let's
say when the battery goes down,then you have to put a new one
in. So then heart gets filled,
Speaker 2 (22:53):
Filling up the heart with little metal little
Speaker 3 (22:55):
Metals. Yes. When you asked earlier about the
future directions, one otherdevelopment that has , uh,
happened and is really pickingup a lot of his steam is , uh,
what they call conductionsystem pacing. So when we put
these wires in the heart, wedon't randomly put it anywhere
in the heart muscle, but weactually put it just onto or
(23:19):
next to the normal electricalwiring of the heart. So you can
think of it that the heart haselectrical wiring, and the way
it is made is the whole heartcan beat in an effective
manner. Now, when weartificially stimulate the
heart from just anywhere, itmay not be as effective of a
(23:41):
synchrony, if you were to say.
So the newer ones, we put thewire specifically next to the
normal wiring of the heart. Sothat is getting more and more
popular, and we are doing moreand more of those types of
devices. So the pacemaker isthe same, but the wire is
slightly different, and theplace where it goes requires a
(24:03):
little more precision aboutwhere exactly you wanna put in
. And that has been shown to bemore beneficial.
Speaker 2 (24:09):
That's super cool.
That's super cool. Many peoplehave heard of ICDs, implantable
cardioverter defibrillators.
We've been talking aboutpacemakers that deal with
arrhythmias of the heart, slowheart rates, complete heart
rock . We're not gonna gettotally into all the reasons
for an ICD , but it's also adevice that's implanted with
wires in your heart. Could yougive us just a little bit of a
(24:30):
comparison of what thedifference between those
devices is ?
Speaker 3 (24:32):
Yes, absolutely. So as I mentioned earlier, the
sole purpose of a pacemaker isto prevent a slow heart rate or
to treat a slow heart rate. Thepurpose of a defibrillator is
to treat a very rapid heartrate, which could result in a
cardiac arrest. So you canthink of it two extremes. Very
slow heart rate is treated by apacemaker, but the purpose of a
(24:56):
defibrillator is purely toshock the heart, or in certain
scenarios, treat that rapidheartbeat just by a pacemaker
function. But essentially, thepure purpose of the
defibrillator, or ICD , is totreat a very rapid heartbeat or
a cardiac arrest.
Speaker 2 (25:12):
It's like an insurance policy against sudden
cardiac death. Really,
Speaker 3 (25:15):
You can think of it that
Speaker 2 (25:16):
Yeah, that's kind of the clumsy, you know, high
level weight . And we're we'll, uh, perhaps get Dr uh ,
Kareem on the show in thefuture to talk about that too.
There's a lot of conditions ,uh, involving the electrical
conducting system of yourheart. The heart is
fascinating. It just isfascinating. It's, first of
all, a chemical reaction thatthen leads to an electrical
current, which then leads to amechanical pump. It's an
(25:36):
engineer's dream, actually
uh, out there listening theirheart , it has, has a
mechanical and electrical and achemical all put together.
Before I let you go, Dr. Kareem, if you could give three tips
to our listeners when they'rethinking about pacemakers in
their heart, what would youlike them to remember?
Speaker 3 (25:52):
The first and the foremost thing is that the
pacemakers are there to treatyour symptoms. So just do not
go after a number of the heartrate. My heart rate is this
slow. Now I'm gonna feel bad ifsomeone is having symptoms with
that slow heart rate, that iswhat pacemaker is supposed to
do. So that's first thing tokeep in mind. The second thing
(26:16):
is, if needed, they can reallymake a big difference to
someone's life and people canlead as normal of a life as
possible with these pacemakers.
Uh, the third thing is thereare a lot of resources , uh,
which are available if thereare any questions. And the one
that I would , uh, recommendstrongly is Heart Rhythm
(26:39):
Society is a , a NationalSociety for Heart Rhythm
Disorders, and it has a lot ofresources. And there is a
website for patients , uh,specifically it's called
upbeat.org, U-P-B-E-A-T uh ,dot org. It has , uh, a lot of
information about heart rhythmdisorders in general. So
Speaker 2 (27:01):
We can put a link in our show notes to the
upbeat.org at the Heart RhythmSociety. If you wanna learn
more about your heart, I'vebeen talking to Dr. Rahan ,
Kareem Electrophysiologist hereat Hennepin Healthcare and a
colleague of mine. I am notexaggerating listeners. I am
not exaggerating when I saythat if I needed an electrical
procedure done on my heart orone of my loved ones, it is Dr.
(27:22):
Kareem that I would send themto. He is as good as they come.
And I just want to thank youfor being on the episode
Speaker 3 (27:27):
Today. Well , thank you so much, David, for having
me here, and you're toogenerous.
Speaker 2 (27:31):
No, I'm not. Thank you . He is truly the best
electrophysiologist I know.
Thanks for listening to episode11 of the podcast. We have
another one coming up in twoweeks, and I hope you'll join
us. And in the meantime, behealthy and be well.
Speaker 1 (27:44):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:06):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:27):
time, be healthy and be well.
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