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A new technique means patients with heart failure can avoid open surgery. 

Retired scientist Stephen Metcalf, 77, from Winchester, Hampshire, is the first patient in the UK to have this operation, as he tells JO WILLEY.

THE PATIENT

Three years ago, I started waking regularly through the night, but I had no idea why.

I was having routine appointments with a cardiologist every few months as I had undergone a double heart bypass in my early 50s because of blocked arteries — so I mentioned it at one of my appointments.

They gave me an electrocardiogram (ECG) to check the electrical activity of my heart and said I had heart failure. 

Retired scientist Stephen Metcalf (pictured) from Winchester, Hampshire, is the first patient in the UK to have the new heart operation

My heart was so damaged it wasn't pumping blood properly around my body and the lower chambers of my heart were out of sync.

I was told this was partly due to a blockage in the nerve pathways inside my left ventricle (the heart's bottom left chamber, which pumps blood around the body).

This was apparently caused by my underlying heart problems. My cardiologist told me at some point I would need a pacemaker to fix the electrical signalling, otherwise my heart would completely fail.

I didn't think I had symptoms other than disturbed sleep, but looking back I realise I'd been slowing down — I wasn't able to exercise and was finding myself getting tired quickly.

My ECGs were monitored and, a few months later, it was decided my condition was very advanced. I needed a pacemaker to get my heart beating properly again.

Three leads from the pacemaker — which would be put in the skin under my collarbone — would be fed through the veins and attached to the outside of the heart's chambers: one at the top (right atrium) and two at the bottom (left and right ventricles).

Electrical signals from the pacemaker to the wires would synchronise the chambers to beat together.

I had this op in June 2014, but unfortunately they couldn't fit the lead on to the left ventricle because my veins weren't in the right place.

Stephen finally had the two-hour operation in December under general anaesthetic, and says he improved very quickly with 'remarkable' results

They left the leads on the right atrium and right ventricle to at least keep them beating together, and prescribed me drugs to help reduce the workload on my heart.

They said I'd need open heart surgery to fit the lead on to my left ventricle, which I didn't want — it's a major operation.

I was monitored until August 2015 when I was referred to Dr Paul Roberts.

He said he'd been trialling a new tool to help place the pacemaker leads inside the left ventricle via a small incision in the chest, thereby avoiding open surgery.

I jumped at the chance, even if I would be the first patient in the UK to have it.

Illustration of a healthy human heart. Doctors have been trialling a new tool to help place the pacemaker leads inside the left ventricle via a small incision in the chest

My life had started to be very limited: I had stopped driving and travelling, and exercising was difficult because I got tired so quickly.

I was desperate to try it, but I had to wait for the procedure to be approved as a trial, which took more than a year.

I finally had the two-hour operation in December under general anaesthetic. The first 24 hours were a bit rough: I was in quite a bit of pain and stayed in hospital for a couple of days.

But I very quickly improved and it's been absolutely remarkable since then.

A few weeks on, I don't have any noticeable symptoms, I'm back walking a couple of miles a day and I'm driving again.

Thanks to this, I've got a long life ahead of me. I hope that this remarkable procedure will be available to others.

THE SPECIALIST

Dr Paul Roberts is a consultant cardiologist at University Hospital Southampton.

Heart failure affects at least one million people in the UK and occurs when the right and left lower chambers (ventricles) of the heart pump weakly.

A third of patients, including Stephen, also have a condition called left bundle branch block (LBBB), where there's a blockage in the electric pathways in the left ventricle, meaning that the heart chambers beat out of sync.

Patients need to have a pacemaker fitted to help ensure the chambers beat together.

Cardiac resynchronisation therapy (CRT) is a special type of pacemaker that can correct the problem by making each side of the heart contract at the same time, like a normal heart, making the heart pump more efficiently.

Heart failure affects at least one million people in the UK and occurs when the right and left lower chambers (ventricles) of the heart pump weakly

The pacemaker is implanted below the collarbone and has three wires that are fed into veins in the chest and then one by one on to the outside of the right atrium, right ventricle and left ventricle.

The pacemaker emits electrical pulses into the wires and keeps the two sides of the heart contracting together. For 10 per cent of patients, we can't get the third lead to where we need it on the left ventricle because the size and shape of veins supplying the heart aren't right to fit the leads.

Until now, patients faced just putting up with their life-limiting symptoms — which can include breathlessness, fatigue and dizziness — with medication to regulate their heartbeat.

Or they would need to have open-heart surgery to stitch the left wire on to the correct place on the outside of the left ventricle.

But this is gruelling — it takes two to three hours, patients stay in hospital for a minimum of a week and recovery can take up to six months.

To overcome this, we developed a technique where we place the two leads on the outside of the right atrium and ventricle as normal, but implant the third lead inside the left ventricle.

Cardiac resynchronisation therapy (CRT) is a special type of pacemaker that can correct the problem by making each side of the heart contract at the same time

The problem is that in order to get to the left ventricle, we must cross the septum — a skin-like membrane separating the two sides of the heart.

Until now, this has been very challenging as we didn't have tools to cut through it without causing significant damage.

But a new tool called SupraCross RF system allows us to do this carefully. Essentially, it is a flexible tube which has a special tip that emits radio- frequency waves to 'burn' a hole through the septum.

The pacemaker is sewn into place in the usual way under general anaesthetic, through a 4cm incision below the collarbone. The leads going to the right atrium and ventricle are fed through and attached to the outside.

To insert the lead into the left ventricle, an ultrasound probe is first put down the oesophagus to show us we are in the right place.

Then we insert a wire through the 4cm incision and use it as a guide to feed the steerable thin tube with the radio- frequency tip.

We reach the right atrium and put the radiofrequency tip against the septum and activate it — this burns a tiny hole in the septum.

To speed recovery, surgeons have developed a new technique which allows them to prevent heart failure without resorting to open heart surgery

We feed the wire through to the left atrium and down into the left ventricle — then push the third lead down there.

The lead has a small corkscrew on the end, which we place against the left ventricle wall and physically rotate so it screws into the heart muscle.

We pull the wire and ultrasound probe out, leaving the lead in place.

The hole in the septum closes around the lead as the septum is a membrane tissue, similar to skin, so it heals well.

Patients often go home the same or next day with recovery taking a matter of days, compared with open surgery which can take months.

It is still really early days as I am the first to carry out this procedure on two patients.

But it is minimally invasive, could save thousands of lives and see people with heart failure living for much longer — years rather than months.

I can see this being rolled out on the NHS over the next couple of years.n This new procedure costs from £3,000 to £4,000.