Sunday January 20, 2019

Tiny Pacemakers Could Be Game Changers for Heart Patients

A pacemaker is a medical device which uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart

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The tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure.
The tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure. Wikimedia Commons

Tiny, new pacemakers are making headway around the world. One type, the Micra, is keeping 15,000 people’s hearts beating in 40 countries, according to manufacturer Medtronic. One of those people is Mary Lou Trejo, a senior citizen who lives in Ohio.

A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device.

Trejo comes from a family with a history of heart disease. Her heart skipped beats, and she could feel it going out of rhythm. Trejo wanted to do something to advance heart health, so in 2014, she volunteered to participate in a clinical trial for the Micra pacemaker. The device is 24 millimetres long implanted, one-tenth the size of traditional pacemakers.

Traditional pacemakers

Most pacemakers rely on batteries placed under the skin, usually just below the collarbone. Sometimes patients get infections after the surgery or have difficulty healing from the incision.

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Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart. There can be problems with the leads as well.

A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device.
A healthy heart has its own pacemaker that establishes its rhythm, but people like Trejo need the help of an artificial device. Wikimedia Commons

Dr Ralph Augostini at Ohio State’s Wexner Medical Center says a tiny pacemaker like the Micra avoids all of these problems.

“The electrodes are part of the can, and therefore it eliminates the lead,” he said. There’s no incision in the chest to become infected and no chance of complications with the leads.

Small and self-contained

Augostini implanted Trejo’s pacemaker in 2014. He threaded the entire device through an artery in her leg up to her heart. The pacemaker has small, flexible tines that anchor it into the folds of the heart muscle. Once it’s in place, the doctor gives it a tug to make sure the pacemaker is stable before removing the catheter used to place it in the heart.

The Wexner Medical Center was one of the sites that participated in the Micra clinical trial. Since the Micra received FDA approval in 2016, Medtronic has been training more physicians on the procedure. A company spokesman told VOA that this device is becoming available at other centres across the U.S. and countries throughout the world.

Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart.
Traditional pacemakers use leads with electrodes on one end that are threaded through blood vessels to connect to the heart. Wikimedia Commons

Dr John Hummell, a cardiologist at the Wexner Medical Center, has studied the effectiveness of this new generation of pacemakers.

“We don’t leave any wires behind and the pacemaker, the battery, the wire is all just a tiny little piece of metal sitting down in the heart,” he said. Medtronic said the results of the clinical trial showed a success rate of 99.6 percent.

Dr Richard Weachter, with the University of Missouri Health Care, says the leadless pacemakers’ complication rates are about half the rate of traditional pacemakers.

The battery lasts for 14 years and after that, Weachter said, doctors, can implant another one in the same chamber of the heart. They can repeat the procedure a third time if needed.

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The pacemaker activates only when necessary to keep the heart beating normally. Studies show that the Micra and other leadless pacemakers are safe and effective.

These tiny pacemakers are not right for all patients, but as the technology develops, more people will be able to benefit from the procedure. Four years after her implant, Trejo’s doctors say she is doing fine. (VOA)

Next Story

Technology That Allows Real Time Fact-Check May be Here Soon

Adair stressed that his product is nonpartisan. He believes television networks will catch on at some point because they will realize that their viewers want quick fact-checking.

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Trump, Facts
President Donald Trump gives a prime-time address about border security from the Oval Office of the White House, Jan. 8, 2019. VOA

A Duke University team expects to have a product available for election year that will allow television networks to offer real-time fact checks onscreen when a politician makes a questionable claim during a speech or debate.

The mystery is whether any network will choose to use it.

The response to President Donald Trump’s Jan. 8 speech on border security illustrated how fact-checking is likely to be an issue over the next two years. Networks briefly considered not airing Trump live and several analysts contested some of his statements afterward, but nobody questioned him while he was speaking.

Duke already offers an app, developed by professor and Politifact founder Bill Adair, that directs users to online fact checks during political events. A similar product has been tested for television, but is still not complete.

The TV product would call on a database of research from Politifact, Factcheck.org and The Washington Post to point out false or misleading statements onscreen. For instance, Trump’s statement that 90 percent of the heroin that kills 300 Americans each week comes through the southern border would likely trigger an onscreen explanation that much of the drugs were smuggled through legal points of entry and wouldn’t be affected by a wall.

 

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Even Tim Graham, director of media analysis at the conservative Media Research Center, concedes that “we all understand that President Trump has a casual approach to factivity.” VOA

 

The Duke Tech & Check Cooperative conducted a focus group test in October, showing viewers portions of State of the Union speeches by Trump and predecessor Barack Obama with fact checks inserted. It was a big hit, Adair said.

“People really want onscreen fact checks,” he said. “There is a strong market for this and I think the TV networks will realize there’s a brand advantage to it.”

Networks mum

If that’s the case, the networks aren’t letting on. None of the broadcast or cable news divisions would discuss Duke’s product when contacted by The Associated Press, or their own philosophies on fact checking.

Network executives are likely to tread very carefully, both because of technical concerns about how it would work, the risk of getting something wrong or the suspicion that some viewers might consider the messages a political attack.

“It’s an incredibly difficult challenge,” said Mark Lukasiewicz, longtime NBC News executive who recently became dean of Hofstra University’s communications school.

Adair said the system will be automated. Mindful that many politicians repeat similar claims, the database will be triggered when code phrases that have been fact-checked before come up. An onscreen note would either explain that a claim is false or misleading and direct viewers to a website where they can find more information, or provide a succinct explanation of why it is being challenged. He envisions an average of one fact check popping up every two minutes. A network using the service would likely air the speech or debate on a delayed basis of about a minute.

Donald Trump, democrats, government,, pakistan
U.S. President Donald Trump. VOA

Lukasiewicz said network executives would likely be wary of letting an outside vendor decide what goes on their screen. Adair said anyone who uses the system would be given veto power over what information is being displayed.

CNN and MSNBC have been most aggressive in using onscreen notes, called chyrons, to counter misleading statements by Trump, although neither did during the border speech. Among the post-speech analyses, Shepard Smith’s rapid-fire reality check on Fox broadcast during the three-minute pause before Democrats spoke was particularly effective. But critics like the liberal watchdog Media Matters for America said anyone who turned the coverage off when Trump stopped speaking was exposed to no questioning of his words.

Complicated, cumbersome

“There is a responsibility to not just be a blind portal and just let things go unchallenged,” said David Bohrman, a former CNN Washington bureau chief who consulted on MSNBC’s 2016 election coverage. “The goal is a good one. The execution is a challenge.”

A technical junkie, Bohrman said he explored different approaches for real-time TV fact-checking while at CNN, but they ultimately proved too complicated and cumbersome.

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Network executives are likely to tread very carefully, both because of technical concerns about how it would work,. Wikimedia Commons

For networks, an incorrect onscreen fact-check would be a public relations disaster. Politicians also make many statements that a critic might question but isn’t necessarily factually incorrect. For example, Trump’s contention that there is a “crisis” at the southern border: Is that a fact or matter of interpretation?

Rest assured, people will be watching. Very carefully.

Even Tim Graham, director of media analysis at the conservative Media Research Center, concedes that “we all understand that President Trump has a casual approach to factivity.”

But conservatives are deeply suspicious that Trump’s words are being watched more carefully than those of Democrats. They will notice and take offense if Trump is corrected on the air much more than his rivals, he said, no matter if Trump actually makes more false or misleading statements.

Also Read: Technology Makes Home Items Smarter But Creepier

“People aren’t going to trust you,” he said, “because they know what the objective is. The objective is to ruin the president.”

Adair stressed that his product is nonpartisan. He believes television networks will catch on at some point because they will realize that their viewers want quick fact-checking.

“Anyone who criticizes will get criticized for criticizing,” Bohrman said. “But the reality is we may be able to help the viewers.” (VOA)