Think of him as a master electrician for your heart: Laurence Epstein, MD, is an international expert in electrophysiology, the science behind the heart’s electrical system. Dr. Epstein knows just what to do if your heartbeat loses the proper rhythm. He was the second person in the world to implant the Micra AV — the smallest pacemaker made for patients with AV block, a problem that interrupts electrical signals between the chambers of the heart and keeps it from beating normally and pumping blood effectively. As Northwell Health’s director of electrophysiology, Dr. Epstein — along with his team, led by Moussa Saleh, MD — brings this tiny yet powerful solution for heart rhythm conditions to patients across Long Island.

What keeps the heart beating normally — and when might you need a pacemaker? Dr. Epstein answers six key questions.

Your heart is a muscle, and all muscles need electrical signals to contract. When you want to bend your arm,
for example, your brain sends an electrical signal to your arm muscles to tell them to contract. Of course, we can’t be thinking about our hearts beating every second of the day, so the heart has its own electrical system that automatically and continuously sends signals to its muscle cells to make them contract. That’s what keeps your heart beating.

A traditional pacemaker contains circuitry and a set of wires (called leads) that connect it to the heart. Implanting one requires surgery — not open-heart surgery, but surgery nonetheless. And because the device sits under the skin, with leads running to the heart, infection is always a possibility. The battery lasts eight to 12 years, and when it runs down, the pacemaker needs to be removed and replaced, requiring another surgery and further risk of infection. Even between those changes, the leads themselves may become infected, which can be dangerous since the leads are in your bloodstream. Finally, the leads may develop scar tissue around them, which makes extracting them difficult.

Are newer pacemakers safer?

They’ve been getting better in many ways. The Micra AV is a good example. First, it has no wires — that’s why it’s called a “leadless” pacemaker. That eliminates the worry about infection from the wires or having scar tissue form around the wires. The Micra AV is also useful for more kinds of heart rhythm problems than older versions, so it can help more patients.

Another change with the Micra AV is that it’s tiny — about the size of a vitamin capsule. It’s so small that no incision is required to implant it. Instead, we thread the device through a catheter that’s inserted in a vein in your leg and maneuvered up to your heart. The procedure only takes 10 or 15 minutes to perform. And because it’s implanted inside the heart, there’s no bump or bulge under your skin.

Plus, without the need for an incision, you recover faster — activity is restricted for about a week, as compared to four to six weeks with older pacemakers.

What’s great is that we can use these new pacemakers to replace old pacemakers whose leads have become infected. I had a case recently where a 104-year-old World War II veteran had an infection caused by his pacemaker. We were able to remove the pacemaker and wires and give him a Micra AV, and he did really well.