Leadless Pacemakers

Abstract

Leadless or transcatheter pacemakers have recently been introduced to market with important benefits and some limitations. Implanted entirely within the right ventricle, these devices eliminate the need for transvenous pacing leads and pacemaker pockets and thus reduce the risk of infections and lead-related problems. Currently, they offer only VVI/R pacing and they cannot provide atrial sensing, antitachycardia pacing, or AV synchrony. They offer a number of features (such as rate response) and electrogram storage, albeit more limited than in a transvenous system. Real-world clinical data are needed to better comment on projected battery life, which manufacturers suggest will be at least equivalent to transvenous devices. Extracting an implanted leadless pacemaker remains a challenge, although proprietary snare and removal systems are available. However, a leadless pacemaker at end of service may be programmed to OOO and left in place; a revised device may be implanted adjacent. These innovative new devices may have important uses in special populations. Initial data on implant success and adverse events are favorable. Currently, there are two leadless pacemakers available: the Micra™ device by Medtronic and the Nanostim™ device by Abbott (formerly St. Jude Medical).

First Multi-Detector Computed Tomography Evidence of Transcatheter Pacing System Migration and Embolization into the Pulmonary Vasculature

“…TPS therapy has recently been introduced into clinical practice to overcome the short-and long-term complications of traditional transvenous pacemakers (including pneumothorax, pocket hematoma/infection, lead dislodgement/fractures/infections, endocarditis, and pacemaker syndrome); it shows great promise and its applications are expanding, even though current real-world clinical experience remains limited [1,2]. In patients who require solely single-chamber ventricular pacing, the TPS is implanted directly into the right ventricle (RV) via the femoral vein and affixed near the apex or at the midpoint of the RV septum where the operator attains acceptable electrical measurements, eliminating the need for either a lead or subcutaneous pocket.…”