Smaller, smarter, healthier

Joe just had a pacemaker implanted to deliver electrical pulses to the right ventricle of his heart, to prevent his heartbeat from stopping and keep him from losing consciousness. His entire pacemaker, about the size of a large vitamin capsule, is slipped directly into place in the heart through a vein. Unlike a traditional pacemaker, there’s no box under the skin and no wires. He goes home a few hours later. Instead of delivering pulses at a preset level every few minutes as the first implanted pacemakers did, Joe’s pacemaker monitors the electrical activity in his heart by the microsecond and delivers pulses only as needed.

“This is a closed-loop system,” says Alan Cheng, vice president for clinical research and therapy development, cardiac rhythm management, at Medtronic, a global medical technology company. Cheng is a clinical electrophysiologist and also serves as an associate professor at The Johns Hopkins University School of Medicine. “The pacemaker has two main jobs: to sense what’s going on in the heart, and to pace the heart if it doesn’t see enough electrical activity. It’s taking inputs on what the intrinsic rhythm is, and if it falls below, the device will start pacing and keep it up until the heart regains its rhythm.”

Joe will still have a follow-up appointment, but his doctor today will have weeks’ worth of data to help answer the critical question, “So, how’s the new pacemaker?” The data collected, from Joe’s pacemaker and thousands of other patients, will help refine the algorithms that monitor the heart and control the pulses.

Such advances in miniaturization and artificial intelligence are enabling the development of ingenious devices to help monitor and treat numerous chronic conditions—not only heart disease, but also diabetes Parkinson’s disease, cancer, epilepsy, obesity, chronic pain, and many others.