Posted on Monday 16 March 2020
Robert Brind and his wife Pauline Brind
Experts at St Thomas’ Hospital have implanted three leadless heart devices in one patient in a world first.
Robert Brind, 63 from Whitstable in Kent, has heart failure caused by a heart attack which left him with severe damage and scarring to his heart. He needs a pacemaker, a cardiac resynchronisation (CRT) device and a subcutaneous implantable cardioverter defibrillator (S-ICD) to keep his heart working well.
After suffering from infections due to the leads in conventional pacemakers, the cardiology team at St Thomas’ realised that Robert’s best option was to have purely wireless systems fitted instead, to keep his heart healthy and prevent a cardiac arrest, while minimising the risk of infection. The wireless forms of the three devices had never been used in one patient before and were implanted in Robert over six months, with the last one being fitted in January.
Robert, a grandfather who works for a construction company, said: “I had a heart attack 15 years ago which was a complete shock. It left my heart severely damaged and I never recovered.
“Afterwards I had problems breathing and almost anything was a struggle, such as climbing the stairs or walking slightly uphill. It was very debilitating because I was suddenly unable to do things I’d always taken for granted.”
In 2011 Robert was fitted with a conventional pacemaker with leads, but it needed to be removed due to a technical fault and two subsequent ones led to infections due to their wires. By then he was being treated by the team at St Thomas’, who decided the best approach would be to use the combination of the three wireless devices.
In August 2019 the leadless Micra pacemaker, which uses electrical pulses to prompt the heart to beat at a normal rate, was inserted in the right side of Robert’s heart. In October the tiny wireless WiSE-CRT system, which works with the pacemaker to ensure both sides of the heart are beating in unison and improves the heart’s pumping function, was fitted in the left side of his heart.
Finally, at the end of January this year the leadless S-ICD was placed under the skin on the left side of Robert’s chest in front of his heart. It acts as a safety net, monitoring the heart and delivering a shock if it detects a dangerous heart rhythm, restoring a normal heart rhythm and preventing cardiac arrest.
Robert said: “I was told I would be the first person in the world to have all three of these wireless devices implanted in my heart. I’m a glass half full type of person so I wanted to go for it if it could help me and push the boundaries of what’s possible.
“There’s no doubt this combination is working better than any devices I’ve had before. I’m more active, breathing better and able to do things I haven’t been able to do for a long time. I feel back to my old self before the heart attack now.
“I’m very grateful to be the first person in the world to have this and if one day it could all be done at once that would be amazing. The care I received at St Thomas’ was absolutely outstanding – the team is wonderful and I’ve had great follow-up care too. I’ve been exceptionally well treated.”
Professor Aldo Rinaldi, consultant cardiologist and professor of cardiac electrophysiology, said: “This is a major step forward because the combination of these three leadless devices had never been performed before. Together they provide complete support for patients without leads. Technologies are evolving all the time and in the future it is likely that all such devices will have no leads and will become more integrated. This is an important step as it is the first proof that the concept works.
“The most important thing is that our patients get the right treatment and Robert has benefitted from being treated in this way. Advantages of using wireless devices in the heart may include a low risk of infection and less chance of interfering with the function of the heart and its blood vessels.”
In order to implant all three devices safely, the team at St Thomas’ worked closely with the manufacturers of the devices: Medtronic (Micra), EBR Systems (WiSE-CRT system) and Boston Scientific (S-ICD). They collaborated to ensure the three systems would interact with each other effectively and provided guidance to the team at St Thomas’, about how to get all three devices to “talk” to each other.