Tiny pacemaker, inserted directly into heart, advances technology Yale doctor first in state to use it

NORTH HAVEN >> It’s only about an inch long, with four tiny prongs and no wires to thread through the chest.

The pacemaker that Joe McAndrew had inserted directly into his heart is the latest technology — still awaiting approval by the Food and Drug Administration — and he said the whole procedure was “like a miracle.”

“It was the easiest thing I’ve ever done and I’ve had a lot of operations,” said McAndrew, 72, a golf pro and teacher from Cheshire. “When I woke up, I didn’t feel anything. I didn’t even know where it was, to tell you the truth.”

The pacemaker, officially known as the Micra Transcatheter Pacing System, was inside his heart, held there by those prongs. “It’s really kind of lumpy and bumpy [inside the heart] so the tines can hook on pretty easily,” said Dr. Eric Grubman, a cardiac electro-physiologist, at his office at the Yale-New Haven Heart and Vascular Center. And it will stay inside McAndrew’s heart, keeping it going at 70 beats per minute, unless he exerts himself. Then, the device will be able to pick up the pace, perhaps increasing to 90 beats per minute.

“It actually works like your inner ear,” with three rings that can tell if the body is accelerating, Grubman said. The ability to increase the pace of electrical shocks “was actually one of the harder tricks that they managed to overcome,” he said. “It’ll turn your heart rate up just like you would normally if you’re moving.”

Once the device has gone through clinical trials, Grubman can use it while it goes through the Food and Drug Administration’s regulatory process, Grubman said.

The device is made by Medtronic, an Irish company, and Grubman estimated its cost at $3,500 to $5,000, which would be covered by health insurance.

Dr. Eric M. Grubman, a cardiac electrophysiologist, the first surgeon in Connecticut to implant the world’s smallest pacemaker, holds the Micra Transcatheter Pacing System. The Micra TPS is one-tenth the size of a conventional pacemaker, and comparable in size to a large vitamin. less Dr. Eric M. Grubman, a cardiac electrophysiologist, the first surgeon in Connecticut to implant the world’s smallest pacemaker, holds the Micra Transcatheter Pacing System. The Micra TPS is one-tenth the ... more Photo: PETER HVIZDAK — NEW HAVEN REGISTER Photo: PETER HVIZDAK — NEW HAVEN REGISTER Image 1 of / 5 Caption Close Tiny pacemaker, inserted directly into heart, advances technology 1 / 5 Back to Gallery

McAndrew has been to some exotic locales as a golf coach, including Monte Carlo, Salzburg and San Tropez. He’s taught on cruise ships by videotaping his students. But he was seriously slowed down by atrial fibrillation, a condition in which the upper chambers of the heart fail to contract regularly.

“The upper chambers weren’t really doing anything,” Grubman said, and he was having issues with his heart’s lower chambers too.

“I’m very active and I would always want to sleep,” McAndrew said. He and his wife, Carol McAndrew, have two children and seven grandchildren, whom they baby-sit.

Besides its small size, the big advantage of the new pacemaker is the lack of wires, which in traditional pacemakers connect the device to the heart.

“To me, I think the most important point is it potentially eliminates a lot of the problems we’ve had with pacemakers over the years,” said Grubman, the only doctor in Connecticut who’s using the new device. With a traditional pacemaker inserted below the skin, “people don’t like how it looks, it gets infected and the wires break.”

“We hope they won’t get infected at all, ever,” he said. “That’s one of the promises of the technology.”

Also, it’s made of titanium, “so you can actually get an MRI with it; it’s MRI safe, which is another thing that pacemakers historically weren’t.”

The device is pushed through a vein from the leg into the heart by a flexible wire.

McAndrew had the procedure done in December and was promised “a good Christmas,” he said. “It was exactly right.”

Call Ed Stannard at 203-680-9382.