A leadless pacemaker is a self-contained device designed to regulate abnormal heart rhythms. This small technology is implanted directly into the heart, differing significantly from traditional pacemakers by eliminating the need for external wires or “leads.” Its purpose is to deliver electrical impulses to the heart muscle, ensuring a consistent beat for individuals experiencing a slow heart rate.
Design and Functionality
A leadless pacemaker is remarkably compact, about the size of a large vitamin capsule. Inside its sealed titanium case, it houses a tiny lithium battery, a miniature computer, sensing electrodes, and pacing electrodes.
It continuously monitors the heart’s electrical activity. When it detects that the heart rate is too slow or irregular, the pacemaker is programmed to deliver precise electrical impulses. These impulses stimulate the heart muscle. The device secures itself to the inner wall of the heart’s right ventricle, using small flexible tines or a screw-in helix for stable placement. Some models also incorporate an accelerometer to enable rate responsiveness, adjusting pacing based on a patient’s activity level.
Implantation Procedure
The implantation of a leadless pacemaker involves a minimally invasive procedure. It is performed by inserting a long, thin tube, known as a catheter, into the femoral vein. Local anesthesia is administered to numb the insertion site.
Using real-time imaging, the physician carefully navigates the catheter through the venous system and into the right ventricle of the heart. Once the catheter is correctly positioned, the leadless pacemaker is deployed directly into the heart muscle and secured. After confirming proper function, the catheter is withdrawn, and pressure is applied to close the incision. This procedure typically takes around 30 minutes.
Distinguishing Features
A key feature of leadless pacemakers is the absence of traditional leads or wires. This eliminates lead-related complications such as fractures, dislodgement, or infections. They are significantly smaller than conventional pacemakers, about 90% to 93% smaller. The procedure also eliminates the need for a surgical incision in the chest or the creation of a “pacemaker pocket” under the skin.
The less invasive procedure avoids a chest incision and surgical pocket, contributing to a reduced risk of infection at the implant site. Patients often experience improved mobility post-procedure, as there are no restrictions on upper body activity. Furthermore, leadless pacemakers are compatible with magnetic resonance imaging (MRI) scans, allowing MRI scans. Battery life is comparable to traditional pacemakers, often lasting between 5 to 15 years.
Patient Considerations and Living With It
Leadless pacemakers are considered for individuals who require single-chamber pacing, usually in the right ventricle. This includes patients with slow heart rates, known as bradycardia, or certain conditions like atrial fibrillation. However, this technology may not be suitable for everyone, particularly those who need pacing in multiple heart chambers or require a defibrillation function.
After implantation, recovery is typically brief, with many patients discharged on the same day or the following day. Patients can usually resume light activities within a few hours to days, though strenuous exercise should be avoided for a short period. Regular follow-up appointments are scheduled to monitor the device’s function and battery status, occurring shortly after implantation and then periodically. Patients should carry a pacemaker identification card, which provides important information for healthcare providers in emergency situations. While most household electrical devices are safe, caution is recommended with items emitting strong magnetic fields.