Scott Webb (Host): Most of us have heard of implantable pacemakers and defibrillators, but what exactly do they do and how do they help patients? Joining me today to help us to understand the basics of heart implant devices is Dr. Manoj Duggal. He's a board-certified cardiologist specializing in cardiac electrophysiology practicing at Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's great to have you here today. We're going to talk basics of heart implant devices and what they are and what they do and how they work and all that good stuff. So, maybe let's just start there. Like, what are the most common heart implants that people get?

Dr. Manoj Duggal: So, when I look at the heart implants which people get implanted with, they fall into two groups. One is electronic devices, and the other are mechanical devices. Electronic devices are which we commonly hear about, pacemakers and defibrillators. When I say mechanical devices, you know, patients with heart failure, they are implanted with devices like an LVAD. My speciality deals more with electronic devices, also called as cardiac implantable electronic devices.

Host: All right. So basically, two kinds and you specialize in one versus the other. But just wondering in general, the role that these heart implants have in helping patients live with heart conditions, survive these heart conditions, like how do they work exactly?

Dr. Manoj Duggal: So, let's focus on electronic devices, which are primarily of two different varieties. One is a diagnostic device which helps you make a diagnosis of a rhythm problem. When I say rhythm problem, we are all born with a pacemaker, which paces of our heart at a certain rate. As we exercise, the heart rate increases. So if we have very slow heart rate, that's a rhythm problem which is generally treated by a device like a pacemaker. If you have very rapid heartbeats, which are serious and life-threatening, those are generally treated by devices like defibrillators.

There's a group of devices which helps make a diagnosis, but they don't treat. And those are tiny chips which are inserted into our skin, which continuously monitor our heartbeat so that we can make a diagnosis what the rhythm problem a person is having.

Host: I see. So as you say, some things are diagnostics, some are actually, you know, doing some work like a pacemaker. What are some of the specific heart conditions that need heart implant devices, you know, so that patients can live healthier, longer lives?

Dr. Manoj Duggal: A pacemaker is a device, which is used for patients who have very slow heart rate. So in other words, when our biological pacemaker or electrical cables in the heart are slowing down and our heartbeat is too slow and it doesn't perfuse enough blood, people can pass out, a pacemaker will help pick up the heart rate, and help maintain a certain heart rate during exercise so that people don't get tired and fatigued. So, that would be one condition which will help patients with very slow heart rates.

And the second group is patients who have had heart problems like somebody suffered a heart attack, and they have a weak heart muscle. A weak heart muscle is generally related to a scar in the heart muscle. A scar in the heart muscle is a substrate for rhythm problems. In other words, it creates short circuits. And these short circuits will trigger very rapid heartbeats, which are potentially lethal. So, we have all seen devices like AEDs, where if somebody passes out, we put an AED. It basically recognizes the rhythm and shocks the heart.

Host: Yeah.

Dr. Manoj Duggal: So, these implanted devices are very similar. So, they have an electrode in the heart, which is connected to a generator and a computer, if you will. And that device will recognize, "Hey, this person is in a bad rhythm," and then it will treat the rhythm by either pacing the heart very rapidly or shocking the heart and bringing them back to life.

Host: Yeah, it's pretty amazing. You know, it sounds sort of like science fiction in a way. You know, implanting things and shocking the heart with computers and generators and all of that. But obviously, you know, it's real, it's happening, it's saving lives. But I'm sure, doctor, especially for folks, you know, who received recent implants, if you will, it's probably overwhelming. So, maybe you could talk a little bit just briefly about some of the keys anyway for patients in managing their devices.

Dr. Manoj Duggal: So, yes, I mean, I think the key in management of these devices should start before the device is implanted. So when I see a patient and say, "Hey, listen, you need a device," a pacemaker or a defibrillator, for them to know what they should expect after it is implanted, what kind of surgery it involves, is done under, you know, anesthesia and what to expect from the level of pain. So now, once you have a device, generally speaking, patients over a period of time, they get used to living with their device. Some of them even forget they have a device. And that's what the goal should be. So, I think the key is to prep them, hey, what to expect.

And now, very commonly asked questions is, "Hey, I have a pacemaker. Will I be able to drive?" The answer is yes. You know, after three to four weeks, once we have stabilized that patient's pacemaker is working what it's doing, then you can drive. "Can I travel?" Of course, when you travel, you'll have a card, and that card will identify you as a patient who has this device and you show it to TSA, so you don't go through those electronic x-ray machines, and that's how you travel. "Can you use microwaves?" Yes. Microwaves are very well-insulated and you can use microwaves.

So, the only things which also is important before you implant these devices is to know what kind of work to do. There are certain work-related machine or tools which don't go well with devices. Most commonly are somebody who does welding. Welding doesn't go well with these electronic devices, so does anything which produces very large electromagnetic fields. I'm not talking about magnets, which you stick in the refrigerator. I'm talking about large powerhouses and things like that.

Host: Yeah, I'm wondering. You know, I feel like I had, you know, received a recent implant and I was trying to get used to it, as you say, the goal is to kind of forget that it's even there, are there things that we do, would need to do, patients would need to do to just kind of adjust their lives? Obviously, avoid the giant magnets, things like that, but just little things, common household things, anything like that, to just make life a little easier?

Dr. Manoj Duggal: have changed a lot in last few years, so everybody asks the question, Hey, what is the upkeep? What do I do with this device? Technology has kind of brought us to a point where you only need to come to our office once a year. Most of the times, we can manage your device remotely, so in other words, get all the information.

So, they will have a base station, which communicates with your device every night. And if there is anything abnormal, it sends the information to our office. And the patient doesn't have to do anything. You know, there used to be time when the patient had to download this information, you know, put something on their device. None of that is needed anymore. From that aspect, it is very seamless, and now we also have certain companies and pacemakers have apps in your phone, so you can actually look at it. "Hey, is the pacemaker working?" Yes, it is working. "Is my battery...?" So normally, these devices have a battery which needs to be changed. You know, average, I would say eight years. And you can say, hey, my battery is still percent left. So, I think that gives you reassurances that, "Hey, A, everything is working," and B, your doctor is aware of what's going on. And then, you know, after initial implant, you're pretty much back to normal. You do not restrict your physical activity, and you live with your life.

The whole goal of this device is so we can get you back to where you were and continue functioning as you did before your device was implanted, or maybe better.

Scott Webb: Yeah. Maybe better. Right. Of course, right? Sort of a bionics, if you will. It's really cool. I've done some podcasts about wearable technology and just to get the sense of, you know, patients being able to sort of see their pacemaker working in real time, check their battery life. And, very little is required of them other than to live their lives, as you say, perhaps even better than they were.

 Good stuff today. Just want to finish up and just give you a chance. Final thoughts, takeaways. When we think about heart. Implant devices and the role they play and how you can help folks, if they come to Franciscan Health, what are your final thoughts?

Dr. Manoj Duggal: My goal is to make them feel as good as they can be. Of course, you know, what you're born with is different, but now you have an implanted device so that your functionality is as good as good can be. And, B, being able to live with that device. So in other words, accepting that device as part of you and be healthy as you can be. And I think the goal is to make them feel good and back to their lives.

Host: Yeah, get back to their lives, kind of forget that it's there. Hopefully, it's doing its thing, which you can always check if you want to. I feel like that's something that I would do because I love playing with my phone. I feel like I would just be sitting there staring at my pacemaker, you know, just making sure that it's working. But hopefully, for most folks that, as you say, they can kind of forget about it and get back to living, which is great. So, thank you so much.

Dr. Manoj Duggal: Yep. All right. Have a good rest of the day.

Host: And to learn more, visit franciscanhealth.org and search heart care. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.