Leadless Pacemaker

Baran Kilical MD

Content Contributor

Evolution of Leadless Pacemaker

There are many types of pacemaker with some helping assist the sinus node by pacing the heart’s top chambers referred to as atria, some assisting by pacing in the bottom chambers called the ventricles, and some that have three wires and can pace atria as well as both ventricles. The type selected will depend on if the main issue is with the heart’s sinus node, AV node, or both. The three wire systems, referred to as biventricular pacemakers, can help assist with sinus node, AV node, and help improve heart efficiency and ejection fraction in patients with a weakened heart (cardiomyopathy). The leadless pacemakers have no wires and are contained in a small bullet size unit. As there are no wires, there are fewer components to fail and less likelihood of infection. At the present time, these can only perform ventricular pacing. For patients who only require ventricular pacing, this is a nice option with less risk of infection, less components to fail, and with quicker recovery time as the arm restrictions that must typically be observed for a month after traditional pacemaker implant do not apply. After a traditional chest wall pacemaker implant, the patient is often advised not to do heavy lifting or extreme motions with their arm. After a leadless pacemaker, the only restriction is to avoid heavy lifting for a few days. Leadless pacemakers aren’t for everyone and may not be suitable for those who require pacing in the atria.

Technology Spotlight

Micra and Micra AV

Medtronic currently makes the only FDA approved leadless pacemakers (Micra and Micra AV). The Medtronic leadless pacemaker is implanted through the femoral vein. A small hole is made in the femoral vein (near the
groin) and a catheter (a thin tube) is advanced to the heart. Through this thin tube, the leadless pacemaker is placed in the ventricle and held in place by tines (thin wires) that embed into the heart muscle. The pacemaker is then checked using a wireless bluetooth connection and the tube is removed. There is no incision on the chest to place the pacemaker. As there are no wires and no chest incision, there are no arm activity restrictions. The main restriction is no heavy lifting for one week before resuming all usual activities.