Leadless cardiac pacing systems: current status and future prospects

Abstract

Introduction: Permanent transvenous pacemaker therapy is an essential management option in patients with symptomatic bradyarrhythmias, but harbors a concomitant risk of serious complications. As most complications are lead-or pocket-related, intracardiac leadless pacemaker therapy has the potential to positively impact patient outcome. Since the first leadless pacemaker implant in 2012, many studies have been conducted to evaluate the effectiveness, safety, and applicability of this novel pacing approach.Areas covered: This review will cover the current status of leadless pacemaker technology. Available safety and efficacy outcomes, current area of indication, and end-of-life management will be evaluated. Furthermore, future perspectives for clinical practice and new pacing modalities are discussed. Expert opinion: The first-generation leadless pacemakers are a promising innovation that provide safe and efficient single-chamber pacing therapy without the use of transvenous pacemaker leads. Yet, broad implementation of this technology is hampered by limitations of the current leadless devices, such as end-of-life management and its single-chamber pacing indication. Further innovations such as leadless dual-chamber pacing therapy, leadless cardiac synchronization therapy, energy-harvesting leadless pacemakers, communicating leadless pacemakers with subcutaneous implantable cardiac defibrillators, and minimally invasive completely extracardiac pacemakers are currently being developed that have the potential to become major game changers in pacing therapy.

Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management

“…Contrastingly, patients with LPs have been shown to have superior physical function, mental health, and significantly lower pacemaker-related discomfort [ 9 ]. Indications for leadless pacing include atrioventricular (AV) block with atrial fibrillation, bradycardia, and AV block or sinus node disease that does not require frequent ventricular pacing [ 1 , 10 ].…”

“…The Micra VR can be remotely interrogated via the CareLink system [ 11 ]. It is 1.5 T and 3 T MRI conditionally compatible and allows for rate-responsive pacing and automated pacing capture threshold management [ 1 ]. Furthermore, Reynolds et al demonstrated the Micra VR had significantly fewer major complications compared to a historical cohort of patients that received transvenous pacers [ 2 ].…”

“…Since the first successful implant in 2012, increasing numbers of leadless cardiac pacemakers (LP) have been placed for indications such as symptomatic bradycardia [ 1 ]. The Micra VR transcatheter pacing system (TPS) from Medtronic was approved by the US Food and Drug Administration (FDA) in April 2016 [ 2 ].…”

“…The purpose of this device is to eliminate the need for a pacemaker pocket and transvenous leads that are common sources of complications in conventional transvenous pacemakers. The Micra VR leadless pacemaker is a viable alternative to transvenous pacemakers in patients indicated for single-chamber ventricular demand (VVI) pacing leading to the devices becoming commonplace in anesthesia practice [ 1 ]. Thus far, only other case reports have been the source of guidance for intraoperative management of these devices.…”

Battery‐Free and Wireless Technologies for Cardiovascular Implantable Medical Devices

“…Figure 2A-N presents the milestones in the evolution of cardiovascular implants and corresponding feasible power strategies over the decades. [19][20][21][22] Emerging cardiovascular Milestones in the cardiovascular implantable devices and corresponding power strategies: Cardiovascular implants: A) first successful pacemaker implantation in 1958; [7] B) the first successful implantation of a left ventricular assist device lasted for 10 days until the patient completed the heart transplant; [19] C) the first ICD was implanted in a patient in 1980; [20] D) the first coronary stent implanted in a patient coronary artery by Sigwart et al in 1986; [21] E) the first leadless pacemaker was implanted in 2012. [22] Power strategies: F) Nikola Tesla achieved inductive power transfer by using a pair of coils in 1889; G) the first far-field wireless microwave transfer was developed in 1964; [191] H) magnetic resonant coupling; [159] I) capacitive coupling; [173] J) mid-field WPT.…”