Pacemakers are truly a wonderful thing and have no doubt saved the lives of millions of people around the world who have had them inserted. But that’s not to say that the medical profession is not looking for a better way.
That is exactly the role of medical professionals – find a way to keep people alive, and then look for a better way to do it. Without that constant curiosity to find a better way, advancements just don’t happen.
When it comes to pacing the heart, His Bundle pacing is the latest advancement to capture the attention and minds of those in the business. And, as Cardiologist and Electrophysiologist, A/Prof Uwais Mohamed explained, the early results are very encouraging indeed.
Uwais has been at the forefront of His Bundle pacing in Australia, and over the last 18 months, has spent much time educating colleagues both in Australia and world-wide on the latest developments in the world of pacemakers and in particular, His Bundle pacing.
So what it is exactly, and how different can it really be?
His Bundle pacing, as Uwais explained, is a concept that has been known for decades, but only in recent times has it been possible, with advancements in technology allowing surgeons to perform the procedure safely and effectively. “His Bundle pacing is a complete paradigm shift in how we think about and pace the heart.”
What makes His Bundle pacing so different to the traditional pacemaker?
Uwais explains it so simply… “A pacemaker system consists of a battery that sits under the collar bone connected to cables that pass in to the top and bottom chambers of the heart. We all have a natural pacemaker, which sits at the top of our heart and sends electricity from the top of our heart, through the natural His Bundle cable into the bottom of the heart. Now, the bottom of the heart is like a dense forest, yet it has specialised electric pathways for the electricity to travel through it quickly. This is important to ensure all parts of the heart are coordinated when they contract.”
“When your natural pacemaker and ‘its cables’ are experiencing problems, and a new pacemaker needs to be inserted, the traditional method is to insert the artificial pacemaker cable into the bottom of the heart, where the electricity then needs to travel through this ‘dense forest’, ignoring the natural pathways through which the electricity would normally travel. This results in electricity travelling through the heart slower and the two sides of the heart not communicating with each other in an effective way.”
“His Bundle pacing, however, involves the pacemaker being inserted into the cable that connects the top of the heart to the bottom of the heart, where the His Bundle is. This then allows the electricity to once again pass quickly through those natural pathways in the bottom of our heart. This results in the two sides of the heart ‘talking to each other’ once again in a coordinated and effective manner.”
While Uwais has an amazing ability to simplify ridiculously complex concepts, His Bundle pacing is not as straight-forward as he makes it sound. “There is a learning curve with this type of operation. But it’s continuing to evolve and more and more surgeons are starting to do it as they realise the benefits of this approach.”
This approach to pacing is still new in Australia and a significant number of the cases performed in Australia have been by Uwais and his team. In this part of the world, Uwais is leading the education on His Bundle pacing, and is working very closely not only with other Australian teams, but also with other centres in the US, Europe and other parts of the world.
His Bundle pacing is new and exciting, for sure. But it may be a while before we see it as the norm for this kind of procedure. As Uwais pointed out, “for all pacemakers inserted in Australia, His Bundle pacing is probably less than 5%, but that number is growing as more and more evidence grows to support that this is a superior technique to the traditional method.”
This obviously begs the question – what have the results been like so far?
The answer? “While it’s relatively new, the results we’re seeing already from this type of pacing are excellent. We’ve always known intuitively that it makes sense, but now we’ve got the tools to make it real. From a patient’s point of view, whichever method you use to install a pacemaker, both will address the acute electric problem, so that’s a win. Where His Bundle pacing has the advantage is that you do it in a way that’s physiologically normal. So we’re activating the heart the way Mother Nature intended. This obviously reduces the problems of the traditional approach.”
So time will tell, but the body of evidence is growing that His Bundle pacing is going to feature prominently when it comes to pacing the heart in the future. And as our medical professionals like A/Prof Uwais Mohamed continue to look for novel ways to treat patients to ensure they have the very best outcomes, there will always be advancements. As he says… “what keeps me ticking is the thought. There is always a better way to do things, we just need to keep thinking.”
St Vincent’s Private Hospital Melbourne cardiologists lead the way in providing minimally invasive options for treatment of coronary artery disease, pacemaker implantation, electrophysiology studies and structural heart conditions. Our facilities include state-of-the-art cardiac catheter and endovascular suites. The outpatient Echocardiography and Ultrasound facility at St Vincent’s Private Hospital offer bulk billed cardiac diagnostic and general ultrasonography services.
A/Prof Uwais Mohamed is a Cardiologist and Electrophysiologist. He is also an Associate Professor of Medicine through the University of Melbourne. He specialises in the area of implantation and follow up of implantable devices including pacemakers, defibrillators, monitoring devices and heart failure devices. He also has a particular interest in diagnosis and management of arrhythmias including atrial fibrillation, SVT’s and ventricular tachycardias.
His private consulting suites can be found at St Vincent’s Private Hospital, Suite 33, 141 Grey Street, East Melbourne.