Advanced cardiac pacemaker procedure performed for first time in SA

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A new approach to implanting a cardiac pacemaker, the ‘His-bundle’ pacing procedure, has been successfully undertaken for the first time in SA at Netcare Milpark Hospital in Johannesburg.

The ‘His-bundle’ pacemaker pacing procedure was recently completed by a team led by cardiologist and electro-physiologist, Dr Israel ‘Pro’ Obel, at the hospital’s electro-physiology laboratory. “We are delighted to have completed what is, from what we understand, a first in South Africa,” added Obel.

“The patient also required an atrioventricular node ablation to assist in normalising the heart rhythm, which was performed in a follow-up procedure. We are pleased that the patient has responded very well to both procedures,” Obel pointed out.

Obel explained that the ‘His-bundle’ is electrically connecting the upper and lower chambers of the heart. “This new form of pacing uses a typical pacemaker, but with a special screw-in lead to pace the heart via the ‘His-bundle’ – cluster of cardiac fibres responsible for electrical conduction in the heart. Traditionally, the right ventricle of the heart would be used,” he explains.

“In appropriate patients, ‘His-bundle’ pacing is a better long-term option than a traditional pacemaker since it follows the natural rhythms of the heart-beat. In the right patients it tends to place less strain on the heart and offers better results over the long term.”

“The ‘His-bundle’ pacing is a somewhat more intricate procedure than the typical lead placement for a traditional pacemaker. While we have not as yet had the benefit of longer-term clinical trials, excellent outcomes are being achieved internationally and we fully expect this to go on to become a standard procedure both locally and abroad, for those patients who qualify for it.”

“It should be noted that ‘His-bundle’ pacing is not appropriate for all patients who require a pacemaker. Suitability depends on the specific anatomy of the patient’s heart and the condition of the His-bundles,” adds Obel.

A heart rhythm disorder or cardiac arrhythmia is when the heart beats too quickly, too slowly or irregularly. This is caused by a fault or faults in the electrical circuitry of the heart. Electro-physiology is the study of the electrical properties of the heart’s cells and tissues and aims to diagnose and successfully treat cardiac arrhythmia.

“While many South Africans are unaware of the medical condition, an irregular heart beat or arrhythmia is actually quite common, and in some cases can be extremely serious, causing a sudden, cardiac event such as heart failure.”

A pacemaker is surgically implanted to assist in keeping the heart pumping at a regular pace. It is generally used in cases in which the heart is beating too slowly. “The traditional form of right ventricular pacing is highly successful and presents a low risk treatment option for most patients with heart rhythm problems who require a pacemaker. In certain patients, however, right ventricular pacing can cause dys-synchrony, which is a difference in the timing of contractions in the different ventricles of the heart,” observes Obel.

“When the ventricles are not in sync it may cause the pumping function of the heart to deteriorate over time. ‘His-bundle’ pacing offers an important new option for these patients.”

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