In Israeli first, Gazan girl receives new kind of pacemaker in innovative procedure

For the first time in Israel, a new kind of pacemaker was implanted in a child using innovative methods. It was the first time the pacemaker — identical to the one Prime Minister Benjamin Netanyahu received in July — was implanted by catheterization through the patient’s neck rather than the groin.

The recipient of the new pacemaker in the unusual procedure performed earlier this month was an 18-year-old from Gaza named Shahad, who was treated at Wolfson Medical Center in Holon through Save A Child’s Heart.

Save a Child’s Heart is an Israeli humanitarian organization working internationally to save the lives of children from countries where access to pediatric cardiac care is limited or nonexistent. Founded at Wolfson in 1995, Save a Child’s Heart has saved the lives of almost 7,000 children from 70 countries and has brought more than 150 healthcare professionals to Israel for training.

Conventional pacemakers, which help maintain normal heart rhythm, are surgically placed under a patient’s skin into the chest near the collarbone, and then electrical leads are introduced into the heart via a catheterization.

This new pacemaker, the Micra produced by Medtronic, is placed directly into the heart and has no leads. It is smaller than a conventional pacemaker — around the size of a large vitamin capsule or the tip of an adult finger — and involves no surgical incision or scarring. Another advantage is its battery life of at least two decades — far longer than older devices.

“We’ve been treating Shahad since she was a young child. She has a complex [anatomical] heart malformation. All the major parts of her heart are inverse,” explained Dr. Sagi Assa, Senior Pediatric Cardiologist at Save a Child’s Heart and Head of the Pediatric Interventional Cardiology Unit at Wolfson.

Dr Sagi Assa, Senior Pediatric Cardiologist at Save a Child’s Heart and Head of Pediatric Interventional Cardiology Unit at Wolfson Medical Center in the cardiac catheterization lab. (Courtesy of Save a Child’s Heart)

“Usually this kind of situation goes along with a heart block, or a problem with the heart’s natural pacemaker, that develops by the age of one,” Assa added.

This was the case with Shahad, and she had to have a pacemaker implanted. Unfortunately, infections kept developing around the pacemaker leads inside her heart.

“We replaced her pacemaker several times over the years, but her body kept rejecting them. She also developed inflamed scar tissue at the site of the implantation in her chest. No matter how we treated her with local and systemic antibiotics and other treatments, the problem kept recurring,” Assa said.

The advent of the new kind of pacemaker provided the Save A Child’s Heart team with an opportunity to help control Shahad’s heart arrhythmia and avoid the complications she has repeatedly experienced.

However, the doctors faced the obstacle posed by the fact that Shahad was born with a condition called interrupted inferior vena cava, meaning that she is without a major vein connecting her lower body to her heart. Without this large vein via which the Micra pacemaker is fed to the heart through a relatively large catheter tube, the medical team would have to find a different method to implant the device.

Dr. Sagi Assa, Senior Pediatric Cardiologist at Save a Child’s Heart and Head of Pediatric Interventional Cardiology Unit at Wolfson Medical Center, with a Palestinian patient. (Courtesy of Save a Child’s Heart)

“We would obviously prefer to go through the groin, especially in children, but in Shahad’s case we had to go through the neck, which is risky,” Assa said.

“We had to bring both the pediatric cardiology and electrophysiology team together to do this. The procedure itself is short, but it has to be planned carefully,” he said.

The advantage to going through the neck is that the catheter goes straight through a vein to the heart’s right ventricle where the pacemaker must be placed. The disadvantages are that the size of the catheter tube is very large relative to the size of the vein, and the puncturing of the neck has to be very accurate to avoid damaging nearby arteries and blood vessels leading to the brain.

The procedure involved only making the small puncture into the vein in the neck, and no use of a scalpel.

“You don’t need to have any cut. There is no need for a knife. The recovery and everything is much better, especially for this child. This meant nothing external to the heart and no material below the skin, which had led to complications for her in the past,” Assa said.

Dr. Michael Geist, Director of the Electrophysiology and Pacemakers Unit and Dr Alona Raucher, Head of Pediatric Cardiology at Wolfson Medical Center, with patient Shahad and her mother. Eighteen-year-old Shahad from Gaza is the first child to be implanted with a new kind of heart pacemaker in Israel. It was also the first time the implantation was done through a catheter in the neck rather than the groin. September 2023. (Courtesy of Save a Child’s Heart)

After recuperating at the Sylvan Adams Children’s Hospital and the International Pediatric Cardiac Center of Save a Child’s Heart at Wolfson, Shahad was released and returned home to Gaza.

After the surgery, her mother said, “I was very scared for Shahad, and I thank Save a Child’s Heart and the medical team for the help and life-saving care they provided to my daughter.”

Despite her medical condition and several long hospitalizations that interrupted her high school years, Shahad successfully passed all her final exams and graduated. She has begun studying technology and graphic design at a university in Gaza.