Cardiology Newsletter November – Pacemakers/Arrhythmia and More from

The Heart, Electrophysiology, Pacemakers and Defibrillators!

Welcome! To THE PAD Monthly – Edition 2 – The Dust is Settling – November 2013.

Editors letter,
What can I say… except THANK YOU! the website is continuing to grow and shows no signs of slowing which leads me to believe I have started something that will be here for the duration! Like when you have your Body Mass Index, Blood Pressure and ECG taken at the doctors to assess your progress the online world isn’t so different. So at time of writing THE PADS vital statistics are as follows:

Email Subscribers: 174
Facebook ‘Likes’: 218
Twitter Followers: 1457
Daily Hits: 250-400 per Day!!!

I do not accept any congratulations for this because these are YOUR statistics – the success of the website is down to you guys! 🙂 

Developments with T.H.E. P.A.D.

I know have finally sorted myself out a Google+ Account if any of you guys are on there? Feel free to come and Join my Circle (a Google+ term I am struggling to understand) – if you get it you can click on this link

However me entering another social network platform is boring compared to some of the exciting developments that are in the pipeline!…

Having been to the Heart Rhythm Congress 2013 (a massive education and networking conference for professional AND patients!) I am genuinely excited about the scientific developments surrounding arrhythmia management and pacemakers… So much so I have dedicated part of this Newsletter to this incredible event!

Heart Failure Page – is currently about to enter talks with a third party about a heart failure section on the website – which will hopefully be a great information portal for these patients, their families and the healthcare professionals that treat and monitor them. Remember the whole point of THE PAD is to educate and Heart Failure is a very misunderstood area!

This month will also be the start of some video reviews that I have in the pipeline! Having written 10,000 words on handheld heart monitors, I would say I am very much in the position to pass judgement on one of the coolest and most accessible to hit the market to date! So keep an eye out for this review. Another video review will be explaining how ICD’s decide whether to shock an arrhythmia and how this is like a game of Guess Who!

Thank you for reading,

Time for a poor excuse for a contents page….

  • The Heart Rhythm Congress 2013 and some spiffing new technology!
  • The Pacemaker Pocket – A look back at the first implantable pacemaker!
  • Sports Clubs the Drive for AED’s – A Footballers Collapse hammers home the need for Defibrillators at Sports Clubs.
  • PADlocks – This is here to stay, a list of the months posts.
  • Good Cause of the Month – American Heart Association – Americas leading CPR educators and much much more! Why not book yourself on a course?
  • Award for ‘Impossible to Drop in to General Conversation” This months winner – Hypertrophic Obstructive Cardiomyopathy.
  • Fish Up A Tree – It doesn’t belong.
  • App Reviews – Got a Smart Phone? Then use it to be smart!
  • Cardiac Facts – The heart is amazing and here is the proof!
  • Wordsearch – Who doesn’t love a word search and it isn’t even that simple!

Heart Rhythm Congress 2013!

It would be a huge lie if I said that part of the reason I loved the HRC 2013 was the food and the drink and the incredible view from my 24th floor hotel room!

Above and beyond this, I enjoyed the HRC so much because of the incredible innovation on show! I could write about this subject all day but I had a few highlights that I know would interest you guys the most and I have included these below!

WAIT!!!!! Just before you get onto the exciting innovations I would like to thank a few people that made my time so productive and enjoyable at the HRC 2013. These people all went above and beyond their job role to supply myself and ultimately you guys with information!:-

Nicola Surrey – Medtronic
Sonia Thareau – Sorin
Carl Struyk- Boston Scientific
Neville Johns – St Jude Medical

P.s. All the staff at  the Hyatt Regency Hotel Birmingham, the customer service was first class!

Thank you all!

Leadless Pacemakers! 

If you have been reading you would have recently seen the St Jude Nanostim – a Single Chamber Pacemaker that fits inside the right ventricle and lasts for about 10 years! Pretty impressive… Now whilst I am definitely not saying this pacemaker is the complete answer to reducing serious infection and lead problems that continue to hamper cardiologists – it is clear to see that it is definitely a step in the right direction and a reason to get excited!! It can’t be long until we have a leadless complex device! Click on the image for the full Nanostim Article! Coming to a Ventricle near you very soon!

The S-ICD Subcutaneous Implantable Defibrillator!

Trying to stick with the theme of leadless devices, this ICD has a lead but it does not enter the heart – again minimising lead complications and complications associated with multiple devices!
Perfect! But as a technician I have immediate concerns about the ability of such a device to do two things successfully!
  1. Accurately Recognise Dangerous Rhythms (VT and VF)
  2. Successfully Treat Dangerous Rhythms (VT and VF)
Well let me put your mind at rest as studies have shown that the S-ICD has –
  • Effective detection and conversion of induced and spontaneous VT/VF episodes.
  • Low rates of significant clinical complications
  • Effective discrimination of AF and SVT from VT/VF
  • Rate of inappropriate therapy is consistent with transvenous ICDs
Also – and this will blow your mind… the S-ICD offers post shock pacing! I will be doing a full post on how this works for sure 🙂

New LV Lead Positioning Techniques!

Now until all this leadless genius solves all our problems, there is still the issue of trying to fit LV leads into awkward anatomy! If you didn’t understand that sentence then please read my post on Biventricular Pacemakers. Essentially we are pushing a pacemaker lead down the network of veins surrounding the heart to the desired position. However we are hampered if the veins are awkward to manoeuvre around (every single person has unique veins)! Previously this has meant leaving the lead in a less desirable position but Dr Guy Haywood discussed new techniques including transeptal (puncturing through the septum) LV lead placement and other positioning techniques that include snare neck catheters and retrograde lead placement. If you don’t have a clue what I am on about – don’t worry I struggled too. In short it is an improvement in our capacity to help individuals with Heart Failure and difficult anatomies. Exciting Times!

The NEW Medtronic – (I can’t say yet!)

So this is a big tease! I was also introduced to a fantastic piece of innovation that is going to change arrhythmia detection forever!
However I cannot share it with you guys just yet! In the cardiology industry there are mutterings and some of you will have guessed what I am talking about! I will be informed by Medtronic the exact moment when i can share this info with you all and I will do so immediately!

I also can’t bring to you just yet a very sexy looking Carelink device which you would be happy to have on show in your house! Lets be honest , the old grey one was designed simply for practicality but this new one will look at home with the stylish designs that we have come more familiar with through companies like Apple.
It will also improve the patient experience and a new feature is included that will make going on holiday less of a headache too!

Got Carelink? You WILL want one of these… Spring-ish 2014

The Pacemaker Pocket!

Well with all that innovation I feel we need to have a quick look back at the first implantable pacemaker… credit where credit is due!
In 1956 silicon transistors became commercially available and catalyzed the development of PRACTICAL Pacing!

Why do we say practical? Well spare a thought for Gerardo Florez, a priest whom’s pacemaker was implanted before the availability of the Silicon Transistor. His pacemaker was external and kept him alive for another 18 years. His first device – connected to his heart externally – weighed 45 kg and was attached to a 12-volt battery. All of which he had to carry around on a cart wherever he went and needed recharging every 72 hours!!!

Fast forward 2 years and advances in technology led to the first implantable pacemaker the Siemens-Elema shown below…

The device was attached to the heart via electrodes connected to the myocardium during thoracotomy – big surgery! The first man to have such a device was this guy…
Arne Larsson – he went on to have 26 pacemakers but sadly died of skin cancer aged 86 in 2001! The irony? he outlived both the inventor – Rune Elmqvist and the surgeon Ake Senning!

I think all of those persons mentioned should take a bow as pioneers in the world of pacemakers! Without them we might still be carrying pacemakers around with us in carts!

Sports Clubs – The Drive for AED’s (Automated External Defibrillators)

A friend of mine who is also a Cardiac Physiologist was recently playing football when a 19 year old opponent collapsed. I have copied and pasted the article from the local newspaper as it confirms what a lot of us all ready know:- for under £800 pound sports clubs could have an AED this should be their priority and there is no excuse for not striving to purchase one.

Article :-

Boss Jim Cooper has spoken of the chilling moment when Met Police striker Tobi Alabi collapsed on the pitch.
The 19-year-old was jogging back from the Molesey penalty area in the 25th minute of Blues’ 7-1 friendly win on Tuesday (October 15) at Imber Court when he stopped and fell to the ground. It prompted memories of Fabrice Muamba, the Bolton forward, who suffered a similar fate at Tottenham in March 2012.
The youngster, who lives in Erith, was able to walk from the field, shower and watch the rest of the match before being driven to Darent Valley Hospital in Kent for tests. He was later admitted and it is understood he may be transferred to a hospital in central London for further analysis of his condition.
“We thought straight away we had a Fabrice Muamba incident on our hands,” revealed Cooper. “There was nobody near him, he just fell backwards and was unconscious. Thankfully, Kristian Webb, Molesey’s defender, was there to help him.”
Webb, who is a Senior Cardiac Physiologist at Royal Surrey Hospital in Guildford, was straight on the scene and reflected: “I didn’t see him fall and at first I thought he was injured.
“I went to assess the situation and he had a good pulse and was coming round after fainting. There were no signs there was anything serious. He was recovering pretty quickly.”
Defibrillator ‘essential’
Webb believes the Muamba incident – and this latest occurrence – has highlighted the need for proper equipment at sporting venues.
“I think that every sports club at whatever level should have an automated external defibrillator [AED],” he added. “It’s paramount and what happened to Fabrice Muamba brought it to the forefront.
“I’m not a doctor but I am trained to use the equipment – but it doesn’t matter how trained a person is, without it I can only do what anyone else can do and that’s give CPR [cardiopulmonary resuscitation}.
“Anywhere there are young athletes putting extra strain on their hearts weaknesses can be uncovered so it is essential in my view.”
Alabi’s condition could be life-changing in terms of playing football again and having visited him, Cooper revealed: “Tobi is very down at the moment because he is unsure about his football career.
“We just have to hope he makes a full recovery.”

Unfortunately it has since been confirmed that Tobi may have to have a Defibrillator (ICD) Implanted due to HCM (Hypertrophic Cardiomyopathy) – I have explained this in this months jargon buster. Needless to say we send Tobi our best wishes.

Full Newspaper Article – Click Here
Would you like to write for THE PAD?
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Good Cause of the Month

The American Heart Association.

Having mentioned CPR earlier I have chosen this cause as it is the USA’s “leader in CPR education training” – They do far far more….

The American Heart Association is the nation’s oldest, largest voluntary organization devoted to fighting cardiovascular diseases and stroke.

Founded by six cardiologists in 1924, our organization now includes more than 22.5 million volunteers and supporters working tirelessly to eliminate these diseases. We fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to save and improve lives.
If you can’t do CPR then please contact a Training Provider – if you are in the States, then why not the American Heart Association. You are most likely to perform CPR on a loved one, wouldn’t you rather you got it right?
Book yourself on an a CPR Course!! CLICK HERE

   App of the Month!

British Heart Foundation Pocket CPR

This FREE App is a fantastic quick educational tool for when to perform and how to perform CPR! Ideally I would love all those people who are not trained in CPR to undergo a full course and learn the skills you might need to save somebodies life someday! HOWEVER this is not going to happen… but whilst you are sat with 10 minutes to spare tonight download this free app and have a read and a practice! You can even use it to simulate CPR and see if your rate and depth are optimal for saving somebodies life!
You might look a bit daft but remember!… “If it is stupid but it works, it isn’t stupid.”
Available Here
Cardiac Facts!

You are most likely to have a heart attack on a Monday morning – Reason for a three day weekend?

An average of 100,000 heart beats a day deliver the equivalent of 2,000 Gallons of Oxygenated blood through 60,000 miles of branching blood vessels.

Remember! Sharing is caring…….


Round Up!

That is the end of my 2nd newsletter! Everything about I have created, I am a one man band and lucky I have an understanding girlfriend who lets me put the hours in!

If you have enjoyed the newsletter or like my website, then much better than any feedback is if you recommend to a friend or colleague! So PLEASE PLEASE take the time to think of two people you know who may like this email and send it there way!

Now put the kettle on and crack on with the Wordsearch! Thats an order Soldier 🙂

PADlocks – This Months Posts One Click Away!
Minimising Ventricular Pacing – Part 3 – AAI <=> DDD
Introduction to Pacemaker Modes:- AAI, VVI & DDD
Heart Attack vs Cardiac Arrest – Whats the Difference
Minimising Ventricular Pacing – Part 2 – 1st Degree HB
Minimising Ventricular Pacing – Part 1 – Why?
Leadless Pacemaker – St Jude Nanostim
Paced Heart Beat and Septal Lead Placement
2:1 Heart Block – Do I Need My Pacemaker
Last Months Newsletter – October 2013
Benefits of a Pacemaker – Patients Stories
Heart Rate Histograms Explained
Living with a Pacemaker – Dr Liza Morton
Award for impossible to Drop into General Conversation…..
*Drum Roll* 

Hypertrophic Obstructive Cardiomyopathy”

Definition:Hypertrophic Obstructive Cardiomyopathy is a abnormal thickening of the heart wall that can lead to:-

  • Lower amounts of blood being pumped with each heart beat.
  • An obstruction of the outflow tract (the route blood takes out the heart) which can also restrict blood flow.
  • The Mitral Valve leaking (valve between the left Atrium and left Ventricle).
  • Occassionally – Abnormal heart rates or rhythms, some life threatening.

Fish Up A Tree

If you were to remove all the empty space from the atoms that make up every human on earth, the entire world population would be no bigger than an apple!


For Professionals


Into Echo? Know someone who is? This incredible reference app lets you know what’s normal and what isn’t when conducting an Echocardiogram. It also allows you to do some of the key calculations:-
  • Body Surface Area (BSA)
  • LV diameter indexed for BSA
  • LV diastolic and systolic volumes indexed for BSA
  • LV mass indexed for BSA
  • E/Em for estimation of PCWP and diastolic function
  • LA volume
  • Aortic regurgitation: regurgitant volume, regurgitant fraction and EROA by volumetric analysis
  • Aortic stenosis: aortic valve area by continuity equation and velocity ratio
  • Mitral regurgitation: regurgitant volume, regurgitant fraction and EROA by volumetric analysis
  • Mitral regurgitation: regurgitant volume and EROA by PISA
  • Mitral stenosis: mitral valve area by pressure half-time
  • Mitral stenosis: mitral valve area by PISA
  • Prosthetic aortic & mitral valves: dimensionless index, EOA and EOA indexed for BSA
  • Aortic root dimension indexed for BSA, age and sex of patient

I know I don’t remember all the normal parameters… keep this on your phone and people will think you have an encyclopedic knowledge!

Whats more… Its FREE!!!! Shut the front door! So why not give it a try – don’t like it? then hit delete!

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