The drive to make medical devices smaller and their implantation more minimally invasive has led to improvements across the entire specialty of cardiology. One of the most visible improvements has been pacemaker technology. While traditional pacemakers work exceptionally well and are very reliable, there has always been the opportunity to improve them, which has come in the form of a leadless pacemaker. Shaped someone somewhat like a pill with a few hooks on the bottom, a leadless pacemaker is inserted into a ventricle and paces the heart without the need for wires or leads running to the muscle. Further, the relatively sizeable traditional pulse generator does not have to be implanted in the chest muscle.
Leadless pacemakers work in a very similar fashion to traditional pacemakers and are meant to be permanent implants. When the pulse generator eventually runs out of batteries, somewhere between 8 and 10 years after implantation, a second leadless pacemaker can be inserted into the ventricle and takes over from where the last device left off.
How We Implant a Leadless Pacemaker
Leadless pacemakers have benefited from the delivery system known as cardiac catheterization. During this procedure, a small incision is made in the groin, arm, or neck through which a spaghetti-like catheter device is passed. The catheter is threaded through a vein and up to the heart using continuous X-ray or advanced ultrasound technology. When the catheter reaches the appropriate ventricle, the tiny leadless pacemaker is deployed and affixed to the wall of the heart chamber. A slight tug ensures that the hooks have seated the pacemaker appropriately and the catheter is removed from the body.
Risks of Implanting a Leadless Pacemaker
All of the inherent risks of cardiac catheterization apply to the implantation of a leadless pacemaker. First, there is a slight chance of excess bleeding or infection at the incision site comma though these are typically managed very easily. There is also a minimal risk of damage to the blood vessel as well as to the structures of the heart through which the cardiac catheter has passed. Once again, these are mitigated by an experienced electrophysiologist and are generally very rare. Finally, the device can malfunction or detach from the ventricle wall, which would require replacement with a new device. Because of the nature of these pacemakers, retrieval of a malfunctioning or spent pacemaker is possible but not usually straightforward enough to perform.
Of course, as with all new technology, there are also limitations. Some patients may require biventricular pacing, which is impossible with current leadless pacemaker technology. However, patients will be happy to know that ongoing clinical trials for a biventricular pacemaker would overcome this obstacle. Of course, we will notify our patients when this becomes a possibility.
Ultimately, leadless pacing is fast becoming the gold standard in pacemaker technology. There will always be applications for a traditional pacemaker, and a consultation with Dr. Moretta will go a long way to understanding which is best for your circumstance. We look forward to helping you with your pacemaker, and please feel free to contact our office if you have any questions.