News | 4 June 2018

New pacemaker technique applied for the first time in the Netherlands

Improved procedure reduces risk of complications

For the first time in the Netherlands, cardiologists at the Heart+Vascular Center at the Maastricht UMC+ have applied a new pacemaker technique that causes fewer complications in the long-term. In this technique, a special catheter is used to locate the heart's natural conduction system before the pacemaker is implanted. The pacemaker lead is then inserted at the right location. This ensures a more coordinated stimulation of the heart than that seen with the standard technique.

Implanting a pacemaker is necessary for patients with a slow heart rate. The device monitors the rate and when necessary, emits a tiny electrical impulse to prevent an abnormally slow heart rate. When a pacemaker is implanted, the wire or lead is normally inserted into the right ventricle. Using this method to stimulate the heart however leads to less coordinated heart contractions. In the long run, this can have a negative effect on the pumping function. The location of the wire is also crucial.

Junction
In order to ensure the heart functions properly, it is necessary for the electrical stimuli to travel through the heart quickly and in a synchronized manner. This makes a stimulus from the central conduction system more effective than stimulation originating in the right ventricle. You can compare it with a road network. If you are at a junction on the highway, you can reach different cities much faster than when you are on a back-country road somewhere. This is also how it works with the pacemaker wire or lead. If you insert this close to the conduction system (the "junction"), the electrical impulse will move through the heart faster and in a more synchronized manner than if you just place the lead somewhere in the right ventricle (the "country road"). It is important is to be able to accurately detect the location of the junction.

Locating
A special catheter makes it possible to locate the exact position of the conduction system. The pacemaker lead is then inserted at the right location using the standard procedure. Cardiologists Dr. Kevin Vernooy and Dr. Justin Luermans of the Maastricht UMC+ recently applied the new technique successfully with two patients. Vernooy: "This is a valuable innovation for our cardiovascular care efforts, and one we would like to put further into practice in collaboration with local area hospitals."