Dr Kerryn Phelps, Health Editor, Channel Nine 'Today', with Tracey Grimshaw

GRIMSHAW: Well, today marks the 10th Anniversary of the death of pioneering heart surgeon, Victor Chang. Dr Chang, of course, set up Australia's first heart transplant program and oversaw the country's first transplant back in February 1984. His work is carried on through the Victor Chang Cardiac Research Unit, and there are many advances still being made in the world of cardio-thoracic surgery and research. To tell us about the latest developments in relation to pacemakers, we're joined now by Today Health Editor, Dr Kerryn Phelps. Morning, Kerryn.

PHELPS: Good morning, Tracey.

GRIMSHAW: U.S. Vice President, Dick Cheney, popped into hospital for day surgery the other day and had a pacemaker installed. It seemed incredible that he could do that so quickly.

PHELPS: Isn't that remarkable, and there's certainly no question that the last ten years have seen tremendous advances in this amazing technology for pacemaking, where people would have otherwise dropped dead or been very severely limited because of their abnormal heart rhythms. Today, they can have a pacemaker, which is, basically, a little computer inserted into their chest with wires down into their heart, and they can live a virtually normal life.

GRIMSHAW: Is it always that straightforward now, to have a pacemaker implanted?

PHELPS: Well, it depends on what the cause of the abnormal heart rhythm is. Some people may not even know they have an abnormal heart rhythm, but other people will notice they've got palpitations, which is a sensitive heart jumping around your chest - they might faint. Some people simply don't know, and their heart goes into an unusual rhythm and simply stops and they're either resuscitated or they die suddenly. Some people may have a stroke, because their heart is fluttering and it makes blood clots that go to the brain. So, it's very important to detect, and it's quite often detected on a general check up, that you have a normal heart rate or an abnormal heart rate and, depending whether it's faster or slower and what type of rhythm it is, you might be able to be treated with medication. Sometimes people will need a type of catheter surgery where they cut out the nerves or a …, this is a vein - the major vein going down into the heart - and it's guided down through and sits down in the ventricle, like that. And if it detects, if the little computer up here detects that there's a low, slow heart rate, then it will fire an electrical impulse and that will make the heart contract normally.

GRIMSHAW: And this can all be done in day surgery. It's just mind blowing.

PHELPS: It's fascinating. People are usually home the next day.

GRIMSHAW: How quickly does a cardiac patient who is, say, a candidate for a pacemaker, feel better after one is implanted?

PHELPS: Well, it will happen immediately because it will start working immediately, and the fascinating thing, too, is that even though this is implanted under the skin, it can stay there for several years and you can re-program it to make sure that it's working properly, and it can be checked without having to open the skin again. It can all be done by computer over the top of the skin. There is also, now, in the type that Dick Cheney actually had inserted, is what's called an implantable defibrillator. Now, this is where the heart goes into, like, a flutter, and that can cause sudden death. And if you go into that particular rhythm, this implantable defibrillator gives the heart a bit of a shock and the heart starts back into a normal rhythm again. Once again, a lifesaving device.

GRIMSHAW: Kerryn, what sort of symptoms would a patient have to have that would make a doctor think that perhaps a pacemaker would be the way to go?

PHELPS: Well, sometimes it will be picked up on a routine examination with an ECG in a person, perhaps, who's getting on a bit. Other times, a patient will come along with a symptom like, 'I feel light headed from time to time', or 'I fainted and I don't know why', or they might have had a stroke and not known that they had an abnormal rhythm. They might feel their heart jumping around in their chest. These are the sorts of things that will alert a doctor to thinking, 'I better check that patient's heart rhythm', and once we know that heart rhythm is abnormal, then they'll go onto treatment. Now, if you have an ECG in your doctor's office, and it's normal, that doesn't necessarily mean that there isn't a problem. So, what you do then is go onto what's called a Holter Monitor which measures your heart trace over a 24-hour period. And you might just see three or four episodes, maybe one episode in the 24-hour period, which shows a dangerous rhythm, and that's when you know what you're dealing with and then the appropriate type of treatment can be advised.

GRIMSHAW: Alright. Thanks, Kerryn. We'll leave it there.

PHELPS: Thank you, Tracey.


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