A Plucky Middlesbrough Grandma who was diagnosed with cardiomyopathy 21 years ago is the first woman in the world – outside of a clinical trial – to benefit from a new type of pacemaker the size of a grain of rice.
Joan Smith, 71, from Marton, has never let her illness get in the way of living life to the full, with husband Alan, 75, five grandchildren and former jobs as a laboratory worker and council receptionist to keep her busy.
However, she admits that now, she “feels like a new woman” since her operation in February, which came after two attempts at fitting a conventional cardiac resynchronisation pacemaker were unsuccesful.
“I felt a lot fitter straight away,” said Joan, after receiving the new pacemaker manufactured by EBR Systems Inc at The James Cook University Hospital.
“I didn’t feel any fatigue at all and it had been fatigue that I had been feeling previously – not breathlessness like some people experience.
“I feel as if I’m a new woman!”
Joan was diagnosed with dilated cardiomyopathy 21 years ago when she experienced “pressure and tightness” in her chest after a bout of flu.
Her own doctor suspected angina, but after being referred to Dr Mark De Belder at South Tees, tests revealed cardiomyopathy.
For two decades, Joan’s condition was stabilised through medication, but after being called in for an echocardiogram last year, she was referred to Professor Nick Linker and his team for a pacemaker.
Two attempts at fitting the conventional pacemaker were unsuccessful, so Joan was referred to Dr Simon James to find out more about the new EBR pacemaker.
Thankfully, Joan is now recovering well after this surgery and her days of exhaustion caused by her condition appear to be behind her.
“I feel very privileged, very lucky, whatever happens now,” said Joan, who will continue to be monitored regularly by the team.
“I know it was a new type of pacemaker and a new procedure, but I trusted the doctors implicitly and knew they wouldn’t have sent me down that road if they didn’t think it was going to be beneficial.”
Joan admits her husband Alan was worried about the procedure and finds it difficult to attend hospital appointments with her as he is so anxious about her condition.
But Joan said: “In my eyes, I could only gain from it and that’s why I took the decision to go ahead.
“I’m pleased I did because I feel a lot brighter and have a lot more energy.
“Before I had this operation, one of the doctors took me for a walk up the corridor and I walked for about six minutes. I could always walk on the flat, but I would get tired.”
After the surgery, Joan found that when she did the same walk again, she could walk for longer – and talk at the same time.
It was then that she realised she’d “adapted to the condition” and had been living with it – rather than getting it resolved.
“I used to sit down for breaks in between doing things and wasn’t even conscious I was doing it whereas, when you’re fit, you don’t need to, you just get on with things,” she said.
“I used to have to push myself to do things like go down to London to visit family and look after the grandchildren, or make arrangements for them coming here, but now, I look forward to it.”
Surgeons and cardiologists conventionally treat the condition with a Cardiac Resynchronisation Therapy (CRT) device, known as a biventricular pacemaker.
This sits below the collar bone and relies on wires that feed into the right chambers of the heart, which perform the vital function of pumping deoxygenated blood into the lungs.
A third wire is required to maintain a steady heartbeat by “pacing” the left ventricle, where blood is pumped out through the aortic valve into the aortic arch and onward to the rest of the body.
But it is thought that – like Joan – up to 30% of patients fail to respond to treatment with these pacemakers – with lead or wire failures being the main complication.
In addition, the right side of the body is not the best location for stimulating the heart.
The new type of wireless pacemaker, developed by EBR Systems Inc and known as WiSE Technology, is implanted directly into the innermost layer of tissue that lines the left chamber of the heart, where it is most beneficial.
A video, courtesy of EBR Systems Inc, below, shows hows the pacemaker works, with the tiny device the size of a grain of rice circled in yellow.
This can then perform the same job as a traditional CRT pacemaker – controlling abnormal heart rhythms using low-energy electrical pulses to prompt the heart to beat at a normal rate – but without the need for wires and the risk of complications that come with them.
Simon James, consultant cardiologist at The James Cook University Hospital, said: “For Joan, as soon as it was switched on there was a huge change in the pumping of the heart. Her blood pressure went up from the moment it was switched on so we felt confident she would begin to feel better quickly.”
Early indications show two other patients are also responding well to this new treatment, which eliminates the need for a left ventricular lead, allowing
cardiologists to target the most beneficial site for pacing the heart.
Dr James said: “It also allows us to fit the device exactly where an individual patient needs it, which could enable us to increase the number of patients who respond to this therapy, helping them to live a longer, more active life.”
During recent clinical trials of the device, patients whose conventional CRT pacemaker treatment had failed benefited from an 81% improvement in their condition.
This led to the device being approved for use in hospitals – with The James Cook University Hospital being the first to take advantage of the new type of treatment on behalf of three patients including Joan outside of a research study.
Andrew Shute, Vice President Europe for EBR Systems, said because WiSE Technology delivers stimulation directly to the inside of the left ventricle, it is seen as being “more consistent with the functioning of a healthy heart”.
“This may explain why it benefits patients who previously failed treatment,” he said.
Studies have demonstrated successful CRT therapy significantly improves symptoms and reduces hospitalisation – and saves lives.
It is thought the new device could improve CRT therapy success rates, improving a patient’s quality of life and helping them to live longer than they would if left untreated, or if their treatment using the conventional CRT pacemaker was unsuccessful.