Heart rhythm disorders: the latest generation of defibrillators installed at the Millénaire clinic in Montpellier

A first intervention took place on February 28. OC SANTE

Correcting abnormalities in the electrical activity of the heart in the most efficient and least invasive way possible: almost forty-five years after the development of a first automatic cardiac defibrillator, in 1980, the Millénaire clinic, in Montpellier, has just installed the third and latest generation of the device. A first in France.

No probe in the veins, and a miniaturized device: the new generation of cardiac defibrillators has arrived in Montpellier, at the Millénaire clinic, the first French establishment to install minimally invasive defibrillators, extravascular, from the company Medtronic.

Dr Nicolas Clementy operated on a first patient on February 28. The cardiologist, who arrived at the Millénaire a year ago, is the doctor who knows the device best: in the study prior to CE marking, carried out at the Tours University Hospital, he installed 28 Aurora EV-ICD implants, the name of the defibrillator.

Dr Clementy trained in the technique at the Tours University Hospital. Midi Libre – MICHAEL ESDOURRUBAILH

Defibrillator, pacemaker, what are we talking about?

"The pacemaker prevents the heart from being too slow, this is the most common problem. Last year, we put 650 pacemakers at the Millennium Clinic, recalls Dr. Clementy.

"The defibrillator is placed to prevent the heart from racing, which leads to sudden death". In 2023, 150 defibrillators were installed at the Millennium.

How it works ? "A third generation defibrillator"

"We are on a third generation of defibrillator. The first technology, which dates from the 80s-90s, is the endocavitary defibrillator", explains Nicolas Clementy. The box, implanted under the collarbone, is connected to electrodes introduced through a vein to the heart."It’s the device that is implanted the most, it is in 90 % of patients. The problem is that the probes are in the heart, they must be removed if they break or become infected. It’is very complicated and the procedure carries a significant risk."

"Le subcutaneous defibrillator, arrived in France a little over ten years, in 2012 is not in contact with the heart chambers, it is very easy to remove. But since we are outside the heart, we are further away, and we have to send twice as much energy to defibrillate the heart. This device, larger and more energy-consuming, which has a lifespan of 6 to 7 years, also has the disadvantage of not being able to provide the function of pacemaker, of stimulation of the heart, which makes it possible to stop tachycardia without send an electric shock".

"The third generationdefibrillator combines the two technologies: the implant is placed under the left armpit and connected to a probe placed under the sternum. We can deliver "normal" and stimulate the heart to prevent it from slowing down or speeding up too much, from the smaller casing, which has a lifespan of 12 to 13 years.

On paper, it's the best of both device worlds.

Why the Millennium Clinic is a pioneer

"I had the chance to participate in the evaluation study’before marketing. The University Hospital of Tours was the center which had put the most into this European, American and Asian study. We had installed 28. It was quite natural that I was able to operate on the first patients after the device was approved, in September 2023 , once heavy administrative formalities have been resolved, explains Dr. Clementy.

A major private cardiology center, it’is "a third of its activity", the Millennium Clinic is "one of the only private centers to have always had a very big innovation process", adds Christelle Bechard, director of the establishment, invests in around fifteen clinical research studies per year.

Other teams are currently starting to install the implant, in Paris and Nantes, at the hospital. In the private sector, the Pasteur clinic in Toulouse, the first private cardiology center in Occitanie, has also trained a team to install the defibrillator.

The team gathered around Dr Clementy after the installation of the first defibrillator. OC SANTE

The target: patients at "high risk of sudden death"

"We implant defibrillators in patients at high risk of sudden death. Sudden death accounts for 40,000 deaths per year, unfortunately, it is often the first episode and the last."

The third generation defibrillator is today reserved for people who have contraindications to the first two, according to the recommendations of the high health authority, which will potentially extend the indications after around a hundred implantations throughout France. "Ultimately, this will represent a third of the defibrillators installed", predicts Dr Clementy .

A first patient, a 52-year-old from Montpellier, was implanted on February 28 with the third generation defibrillator, for the moment " reserved for those who do not have access to the other two technologies. A second, from Toulouse, on March 27. They left the clinic the day after the intervention.

The next intervention will be carried out on an Audois. Around ten defibrillators must be installed by the end of the year.

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