Pacemakers use electrical impulses to stimulate heart pumping when the muscles need help. The Micra Transcatheter Pacing System (TPS) is the world’s smallest pacemaker, measuring about the size of a large pill. The TPS is now available to Riverside Healthcare patients.
Dr. Brad Suprenant, electrophysiologist, explains how this new technology works.
World’s Smallest Pacemaker, the Micra Transcatheter Pacing System (TPS), is Now Available to Riverside Patients
Featured Speaker:
Learn more about Brad Suprenant, DO
Brad Suprenant, DO
Dr. Brad Suprenant, Clinical Cardiac Electrophysiologist, is board certified in internal medicine, cardiovascular disease and electrophysiology and has more than three decades of experience in treating numerous rhythm disorders and diseases of the heart and circulatory system. Dr. Suprenant received his Doctor of Osteopathic Medicine from the Chicago College of Osteopathic Medicine. He then went on to complete a residency in internal medicine and a fellowship in cardiology at Chicago Osteopathic Medical Center.Learn more about Brad Suprenant, DO
Transcription:
World’s Smallest Pacemaker, the Micra Transcatheter Pacing System (TPS), is Now Available to Riverside Patients
Carl Maronich: And we are joined by Dr. Brad Suprenant. Dr. Suprenant is an electrophysiologist with the Riverside Medical Group. Welcome to the podcast.
Dr. Brad Suprenant, DO: Thank you for having me.
Carl: We appreciate you joining us. Today, we’ll be talking about ultimately pacemaker technology and how it’s advanced into now where we’re putting in what's being called the world’s smallest pacemaker. Amazing stuff. As we get into that, we’re going to start with a little bit of your background. You're a local guy.
Dr. Suprenant: I am. I was born at Saint Mary’s Hospital and I grew up here. I went to Stubbins Grade School, East Junior High School and then Bradley Bourbonnais High School.
Carl: Where's your medical schooling?
Dr. Suprenant: Medical schooling was Chicago Osteopathic in Hyde Park.
Carl: Very good. An electrophysiologist. Let's talk a little bit about what that is.
Dr. Suprenant: An electrophysiologist is a cardiologist or heart doctor that specializes in electrical disorders of the heart. We see people with electrical arrhythmias, people dizzy, light-headed, blackout and things like that.
Carl: A lot of different causes for that kind of thing?
Dr. Suprenant: There can be as sometimes there can be significant heart disease related to an electrical disorder of the heart. Sometimes it can be otherwise healthy people. It could be a variable.
Carl: Heart failure, the heart isn't pumping as efficiently as it needs to, which can lead to these symptoms you're talking about dizziness and such?
Dr. Suprenant: Yes, heart failure just means that the heart cannot provide adequate blood support to the body’s functions and organs.
Carl: And the cause of that can be a multitude of things, but what you're able to do is with pacemaker technology, allow the heart to pump better. Is that a layman’s way to put it?
Dr. Suprenant: A predominant function of a pacemaker is to prevent the heart rate from going too slow, so that's basically the primary function of a pacemaker, to prevent it from going too slow. We can use pacing therapy to help with the functioning of the heart and make it pump a little better sometimes with multiple leads, but that's primarily the function.
Carl: From the time you started in medical school to today, I'm guessing there's been quite an advancement in pacemaker technology.
Dr. Suprenant: There has been quite a significant advancement in pacemaker technology. The type of pacemakers, the size of pacemakers, how they're implanted, the diagnostics on the pacemaker to allow us to evaluate patient symptoms and problems has significantly evolved over that period of time.
Carl: As we were talking before, we weren’t on the air here, an open procedure that really required extensive surgery to now that isn’t necessarily the case.
Dr. Suprenant: That’s correct. Pacemakers are put in what we call percutaneously through the skin and traditional pacemakers are implanted through the vein with leads that go through the vein into the heart with a pacemaker device that’s placed in the chest wall.
Carl: Is there still the need for some of the big open procedures to put a larger pacemaker in or are those days gone?
Dr. Suprenant: Those days are pretty much gone. There's no need for that at this point in time.
Carl: To the point where now we’re talking about what's called the world’s smallest pacemaker. Talk a little bit about that. It has a real name besides just that.
Dr. Suprenant: That’s the micratranscatheter pacing systems, so it’s put in through the vein and it’s cosmetically invisible so it’s just like a small pellet that goes into the heart, like the size of a large vitamin.
Carl: Who would be a candidate for that type of pacemaker?
Dr. Suprenant: Patients that just need single chamber pacing that have dizziness or lightheadedness where the heart rating goes too slow that they need the stimulus of the heart to contract, they would be a candidate for that type of pacemaker.
Carl: Heart month last year or the year before, one of the heart months, we did a heart quiz and I'm not remembering all the answers to that quiz and we have the perfect guy here to help us with this. The anatomy of the heart. Are there four chambers?
Dr. Suprenant: There are four chambers of the heart.
Carl: If we said one or multiple chambers aren’t working, that’s what happens to people sometimes?
Dr. Suprenant: Yes. You can stimulate the heart one chamber and the whole heart will contract, but there are advantages sometimes to stimulate the upper chamber and the lower chambers sequentially or even both lower chambers to help with heart failure. The type of pacing device is really select for the patient's needs.
Carl: The youngest patient you’ve ever put a pacemaker into. Is this sometimes that does occasionally happen to younger people?
Dr. Suprenant: It does. Fortunately, the need for younger patients is very few and far between, but I've placed pacemakers in somebody as young as 18 years of age.
Carl: Every case would be different, but whether that individual is going to need to have that for life or is it episodic that they need a pacemaker for a while and then ultimately don’t need one or is it something that you need for life?
Dr. Suprenant: Generally, the intent is once you put the pacemaker in, it’s in there for life because it will scar down and it can be problematic to remove it from the body at that point in time.
Carl: The average age of someone who needs a pacemaker?
Dr. Suprenant: Typically, the elderly population over the age of 60 or 65.
Carl: We’ll talk a little bit about the symptoms. If somebody is feeling not right, generally the first defense would be to go to your primary care provider and if they're telling you they think it’s a heart issue, then they might refer to you or another cardiologist?
Dr. Suprenant: That’s correct.
Carl: Then you would diagnose and decide if a pacemaker is going to be the solution to their problem.
Dr. Suprenant: That’s correct. Typically, we would see people black out, pass out, become extremely dizzy or lightheaded. They will see their primary care physician, they’ll do the cursory workup and then if they feel that could be an electrical disorder of the heart, we will get referred that patient.
Carl: What would be the time from diagnosis to the actual time of putting the pacemaker in most times?
Dr. Suprenant: Sometimes it can be quite quick when it’s pretty obvious and straightforward on just a 12 lead EKG or sometimes it can be long-term where you need further monitoring to determine what the reason is for that problem.
Carl: It sounds like just hearing you have to put a pacemaker in somebody or you now use a pacemaker, that sounds like a very invasive life-changing kind of thing. Is it that way?
Dr. Suprenant: It's invasive, but it's certainly a very small surgical procedure, so it's not a very complicated procedure anymore. The complications associated with the implantation of a device like that is pretty low.
Carl: Once it's in, is it drastic lifestyle changes that the individuals have to go through?
Dr. Suprenant: No. Basically, everything they were doing before, once the device is healed, they should be doing after. The biggest hold back was MRI capabilities, getting MRI scans that are very important for diagnostic measures for healthcare, now recent pacemakers have gotten over that and now you can have an MRI with a pacemaker.
Carl: That's a relatively new technology that you're using.
Dr. Suprenant: Yes. It was approved by the FDA in 2016 so it’s a new technology that’s become available.
Carl: Again, those candidates that are good candidates for this specific pacemaker would be?
Dr. Suprenant: Patients who need just single chamber pacing, who need rate support, meaning the heart rate is too slow that you need to provide them contractility of the heart and the stability to beat.
Carl: Doctors always talk about a healthy lifestyle, exercise, diet, good diet, all those things. That’s going to be the same advice for somebody who has a pacemaker. Are there any kinds of things that they need to be conscious of post-pacemaker?
Dr. Suprenant: Other than the healing of the incision and ensuring that the leads do not dislodge from the heart, we usually tell them to take it easy for a couple weeks, but beyond that, their activity level will be the same once that heals in. We encourage to keep a healthy active lifestyle.
Carl: Back to talking about over the span of your career, the health of the population that you're seeing over the last few decades has been more health conscious, but I don’t know that we really improved our health. We know the things we’re supposed to do and we just don’t enjoy doing them and therefore we don’t. A piece of chocolate is much better than the broccoli I'm supposed to eat. What are you seeing over the course of your patients nowadays?
Dr. Suprenant: Certainly, we all know what we’re supposed to be doing. It’s easier to say than do, but I do see that people are more engaged in an active healthy lifestyle, but it’s a twofold thing. In the hospital, we see sicker and sicker patients every day and it’s mainly because of insurance capabilities and stuff like that that we’re seeing a much sicker population in the hospital but a much healthier population in our offices.
Carl: Most pacemaker procedures are probably just going home the next day or same day possibly.
Dr. Suprenant: That’s correct. Most of them go home the following morning.
Carl: The days of long hospital stays for that kind of procedure, that doesn't happen anymore.
Dr. Suprenant: No, it doesn't.
Carl: Is that a benefit? I think that's a positive thing and people want to get back to their lives more quickly.
Dr. Suprenant: That's certainly very positive and the sooner you can get the patient up and moving and active, it's certainly healthier for the patient. Nobody wants to stay in the hospital anyway.
Carl: The contact that you have with the primary care provider of the patient. Most often times, an ailment or somebody is not feeling well have to go to their primary care doctor. If they're referred to you, then there has to be good communication between you and their primary care doctor. Is that always happening?
Dr. Suprenant: It’s certainly happening and it’s easier to happen now with all the electronic health records and interaction between the physicians now, it’s much easier to communicate than it was before.
Carl: When you started your career, a lot of things have changed, including things like that. Riverside has MyChart, which allows folks to look at the same thing as their doctor is seeing and communicate more directly. Again, all of this leads to a better more health-conscious population.
Dr. Suprenant: It should lead to asking more questions about what does this mean or why do I do this or why do I need this medication?
Carl: Do you see patients come in better informed overall than they used to be?
Dr. Suprenant: I think they are better informed, but everybody needs help to understand what they're reading as well. Sometimes it can be a double-edged sword. Misinterpretation of this information that they're pulling off the Internet, they still need help to understand what that information means.
Carl: We started talking about the small catheter, the micratranscatheter pacing system, and pacing refers to the pacing of the heart, making sure the heart is beating in correct rhythm.
Dr. Suprenant: Correct. It’s to make the heart beat. What people don’t understand is a lot of times, they can have rhythm disorders of the heart and palpations and irregularities and feel that the pacemaker is going to correct that problem. It’s not going to correct that problem. A pacemaker only prevents the heart rate from going too slow. Often times, we will need to give them medications to correct the other problem in addition to the pacemaker or do catheter ablations or things that correct other electrical disorders of the heart.
Carl: Making patients understand all of that, so their expectation is set appropriately.
Dr. Suprenant: Exactly.
Carl: You mentioned medications. Have they affected the number of pacemakers you're putting in these days? Has medication to some degree replaced what pacemakers use to do?
Dr. Suprenant: Unfortunately, medications don't help stimulate the heart to beat faster, so often times medications will slow the heart rate down and we're using those medications to treat other things like heart failure or other rhythm problems. Often times, we have to utilize pacing therapy to allow us to use those medications to treat other issues. They're using a combination a lot of times and unfortunately, there are no good medications that can increase the heart rate where you don't need the pacemaker. It's usually the opposite that maybe we can take this medication away where your heart rate won't be so slow if you don't absolutely need that medication.
Carl: I'm sure we would tell folks if they’re not feeling right to see their primary care doctor. If it’s a heart issue, then they get referred to you. They know they're in good hands and if they need a pacemaker, you're the guy to see.
Dr. Suprenant: I would hope so.
Carl: You can find information about Dr. Suprenant on the Riverside website and we appreciate you joining us for the podcast today.
Dr. Suprenant: Thank you for having me.
World’s Smallest Pacemaker, the Micra Transcatheter Pacing System (TPS), is Now Available to Riverside Patients
Carl Maronich: And we are joined by Dr. Brad Suprenant. Dr. Suprenant is an electrophysiologist with the Riverside Medical Group. Welcome to the podcast.
Dr. Brad Suprenant, DO: Thank you for having me.
Carl: We appreciate you joining us. Today, we’ll be talking about ultimately pacemaker technology and how it’s advanced into now where we’re putting in what's being called the world’s smallest pacemaker. Amazing stuff. As we get into that, we’re going to start with a little bit of your background. You're a local guy.
Dr. Suprenant: I am. I was born at Saint Mary’s Hospital and I grew up here. I went to Stubbins Grade School, East Junior High School and then Bradley Bourbonnais High School.
Carl: Where's your medical schooling?
Dr. Suprenant: Medical schooling was Chicago Osteopathic in Hyde Park.
Carl: Very good. An electrophysiologist. Let's talk a little bit about what that is.
Dr. Suprenant: An electrophysiologist is a cardiologist or heart doctor that specializes in electrical disorders of the heart. We see people with electrical arrhythmias, people dizzy, light-headed, blackout and things like that.
Carl: A lot of different causes for that kind of thing?
Dr. Suprenant: There can be as sometimes there can be significant heart disease related to an electrical disorder of the heart. Sometimes it can be otherwise healthy people. It could be a variable.
Carl: Heart failure, the heart isn't pumping as efficiently as it needs to, which can lead to these symptoms you're talking about dizziness and such?
Dr. Suprenant: Yes, heart failure just means that the heart cannot provide adequate blood support to the body’s functions and organs.
Carl: And the cause of that can be a multitude of things, but what you're able to do is with pacemaker technology, allow the heart to pump better. Is that a layman’s way to put it?
Dr. Suprenant: A predominant function of a pacemaker is to prevent the heart rate from going too slow, so that's basically the primary function of a pacemaker, to prevent it from going too slow. We can use pacing therapy to help with the functioning of the heart and make it pump a little better sometimes with multiple leads, but that's primarily the function.
Carl: From the time you started in medical school to today, I'm guessing there's been quite an advancement in pacemaker technology.
Dr. Suprenant: There has been quite a significant advancement in pacemaker technology. The type of pacemakers, the size of pacemakers, how they're implanted, the diagnostics on the pacemaker to allow us to evaluate patient symptoms and problems has significantly evolved over that period of time.
Carl: As we were talking before, we weren’t on the air here, an open procedure that really required extensive surgery to now that isn’t necessarily the case.
Dr. Suprenant: That’s correct. Pacemakers are put in what we call percutaneously through the skin and traditional pacemakers are implanted through the vein with leads that go through the vein into the heart with a pacemaker device that’s placed in the chest wall.
Carl: Is there still the need for some of the big open procedures to put a larger pacemaker in or are those days gone?
Dr. Suprenant: Those days are pretty much gone. There's no need for that at this point in time.
Carl: To the point where now we’re talking about what's called the world’s smallest pacemaker. Talk a little bit about that. It has a real name besides just that.
Dr. Suprenant: That’s the micratranscatheter pacing systems, so it’s put in through the vein and it’s cosmetically invisible so it’s just like a small pellet that goes into the heart, like the size of a large vitamin.
Carl: Who would be a candidate for that type of pacemaker?
Dr. Suprenant: Patients that just need single chamber pacing that have dizziness or lightheadedness where the heart rating goes too slow that they need the stimulus of the heart to contract, they would be a candidate for that type of pacemaker.
Carl: Heart month last year or the year before, one of the heart months, we did a heart quiz and I'm not remembering all the answers to that quiz and we have the perfect guy here to help us with this. The anatomy of the heart. Are there four chambers?
Dr. Suprenant: There are four chambers of the heart.
Carl: If we said one or multiple chambers aren’t working, that’s what happens to people sometimes?
Dr. Suprenant: Yes. You can stimulate the heart one chamber and the whole heart will contract, but there are advantages sometimes to stimulate the upper chamber and the lower chambers sequentially or even both lower chambers to help with heart failure. The type of pacing device is really select for the patient's needs.
Carl: The youngest patient you’ve ever put a pacemaker into. Is this sometimes that does occasionally happen to younger people?
Dr. Suprenant: It does. Fortunately, the need for younger patients is very few and far between, but I've placed pacemakers in somebody as young as 18 years of age.
Carl: Every case would be different, but whether that individual is going to need to have that for life or is it episodic that they need a pacemaker for a while and then ultimately don’t need one or is it something that you need for life?
Dr. Suprenant: Generally, the intent is once you put the pacemaker in, it’s in there for life because it will scar down and it can be problematic to remove it from the body at that point in time.
Carl: The average age of someone who needs a pacemaker?
Dr. Suprenant: Typically, the elderly population over the age of 60 or 65.
Carl: We’ll talk a little bit about the symptoms. If somebody is feeling not right, generally the first defense would be to go to your primary care provider and if they're telling you they think it’s a heart issue, then they might refer to you or another cardiologist?
Dr. Suprenant: That’s correct.
Carl: Then you would diagnose and decide if a pacemaker is going to be the solution to their problem.
Dr. Suprenant: That’s correct. Typically, we would see people black out, pass out, become extremely dizzy or lightheaded. They will see their primary care physician, they’ll do the cursory workup and then if they feel that could be an electrical disorder of the heart, we will get referred that patient.
Carl: What would be the time from diagnosis to the actual time of putting the pacemaker in most times?
Dr. Suprenant: Sometimes it can be quite quick when it’s pretty obvious and straightforward on just a 12 lead EKG or sometimes it can be long-term where you need further monitoring to determine what the reason is for that problem.
Carl: It sounds like just hearing you have to put a pacemaker in somebody or you now use a pacemaker, that sounds like a very invasive life-changing kind of thing. Is it that way?
Dr. Suprenant: It's invasive, but it's certainly a very small surgical procedure, so it's not a very complicated procedure anymore. The complications associated with the implantation of a device like that is pretty low.
Carl: Once it's in, is it drastic lifestyle changes that the individuals have to go through?
Dr. Suprenant: No. Basically, everything they were doing before, once the device is healed, they should be doing after. The biggest hold back was MRI capabilities, getting MRI scans that are very important for diagnostic measures for healthcare, now recent pacemakers have gotten over that and now you can have an MRI with a pacemaker.
Carl: That's a relatively new technology that you're using.
Dr. Suprenant: Yes. It was approved by the FDA in 2016 so it’s a new technology that’s become available.
Carl: Again, those candidates that are good candidates for this specific pacemaker would be?
Dr. Suprenant: Patients who need just single chamber pacing, who need rate support, meaning the heart rate is too slow that you need to provide them contractility of the heart and the stability to beat.
Carl: Doctors always talk about a healthy lifestyle, exercise, diet, good diet, all those things. That’s going to be the same advice for somebody who has a pacemaker. Are there any kinds of things that they need to be conscious of post-pacemaker?
Dr. Suprenant: Other than the healing of the incision and ensuring that the leads do not dislodge from the heart, we usually tell them to take it easy for a couple weeks, but beyond that, their activity level will be the same once that heals in. We encourage to keep a healthy active lifestyle.
Carl: Back to talking about over the span of your career, the health of the population that you're seeing over the last few decades has been more health conscious, but I don’t know that we really improved our health. We know the things we’re supposed to do and we just don’t enjoy doing them and therefore we don’t. A piece of chocolate is much better than the broccoli I'm supposed to eat. What are you seeing over the course of your patients nowadays?
Dr. Suprenant: Certainly, we all know what we’re supposed to be doing. It’s easier to say than do, but I do see that people are more engaged in an active healthy lifestyle, but it’s a twofold thing. In the hospital, we see sicker and sicker patients every day and it’s mainly because of insurance capabilities and stuff like that that we’re seeing a much sicker population in the hospital but a much healthier population in our offices.
Carl: Most pacemaker procedures are probably just going home the next day or same day possibly.
Dr. Suprenant: That’s correct. Most of them go home the following morning.
Carl: The days of long hospital stays for that kind of procedure, that doesn't happen anymore.
Dr. Suprenant: No, it doesn't.
Carl: Is that a benefit? I think that's a positive thing and people want to get back to their lives more quickly.
Dr. Suprenant: That's certainly very positive and the sooner you can get the patient up and moving and active, it's certainly healthier for the patient. Nobody wants to stay in the hospital anyway.
Carl: The contact that you have with the primary care provider of the patient. Most often times, an ailment or somebody is not feeling well have to go to their primary care doctor. If they're referred to you, then there has to be good communication between you and their primary care doctor. Is that always happening?
Dr. Suprenant: It’s certainly happening and it’s easier to happen now with all the electronic health records and interaction between the physicians now, it’s much easier to communicate than it was before.
Carl: When you started your career, a lot of things have changed, including things like that. Riverside has MyChart, which allows folks to look at the same thing as their doctor is seeing and communicate more directly. Again, all of this leads to a better more health-conscious population.
Dr. Suprenant: It should lead to asking more questions about what does this mean or why do I do this or why do I need this medication?
Carl: Do you see patients come in better informed overall than they used to be?
Dr. Suprenant: I think they are better informed, but everybody needs help to understand what they're reading as well. Sometimes it can be a double-edged sword. Misinterpretation of this information that they're pulling off the Internet, they still need help to understand what that information means.
Carl: We started talking about the small catheter, the micratranscatheter pacing system, and pacing refers to the pacing of the heart, making sure the heart is beating in correct rhythm.
Dr. Suprenant: Correct. It’s to make the heart beat. What people don’t understand is a lot of times, they can have rhythm disorders of the heart and palpations and irregularities and feel that the pacemaker is going to correct that problem. It’s not going to correct that problem. A pacemaker only prevents the heart rate from going too slow. Often times, we will need to give them medications to correct the other problem in addition to the pacemaker or do catheter ablations or things that correct other electrical disorders of the heart.
Carl: Making patients understand all of that, so their expectation is set appropriately.
Dr. Suprenant: Exactly.
Carl: You mentioned medications. Have they affected the number of pacemakers you're putting in these days? Has medication to some degree replaced what pacemakers use to do?
Dr. Suprenant: Unfortunately, medications don't help stimulate the heart to beat faster, so often times medications will slow the heart rate down and we're using those medications to treat other things like heart failure or other rhythm problems. Often times, we have to utilize pacing therapy to allow us to use those medications to treat other issues. They're using a combination a lot of times and unfortunately, there are no good medications that can increase the heart rate where you don't need the pacemaker. It's usually the opposite that maybe we can take this medication away where your heart rate won't be so slow if you don't absolutely need that medication.
Carl: I'm sure we would tell folks if they’re not feeling right to see their primary care doctor. If it’s a heart issue, then they get referred to you. They know they're in good hands and if they need a pacemaker, you're the guy to see.
Dr. Suprenant: I would hope so.
Carl: You can find information about Dr. Suprenant on the Riverside website and we appreciate you joining us for the podcast today.
Dr. Suprenant: Thank you for having me.