A pacemaker is a tiny device that sends electrical impulses to the heart for normalising its rate and rhythm. It is used for treating arrhythmias when the heart beats too slowly. Traditional pacemakers consist of a pulse generator, leads (wires) implanted in the vein (subclavian, axillary or cephalic) that transmit impulses to the heart and electrodes for sensing the normal heartbeat. They are placed in the left or right chest by a mini-surgery and connected via wires to electrodes in one of the heart chambers (right atrium, right and left ventricles).
The traditional pacemaker has undergone several improvements, including a reduction in generator size, better battery quality and life, lead fidelity and refined pacing algorithms. However, these pacemakers have two disadvantages with the leads and the subcutaneous pocket for the generator. These can cause complications including lead displacement or fracture, infection, cardiac tamponade (when air, fluid or blood accumulates in a sac surrounding the heart, preventing it from pumping enough blood to the body) and rarely pulmonary complications.
The leadless (wireless) pacemakers overcome the weaknesses of traditional pacemakers, as they are much smaller (3-4 cm). The pulse generator and electrodes are all embedded in one single device. There is no need for a separate battery or wires as a single device is implanted into the right ventricle via the femoral vein transcatheter approach under local anaesthesia. The leadless pacemaker has a similar battery life to the traditional pacemaker (5-15 years). These pacemakers are suitable for wide range of patients needing pacemakers like those with patients who are very frail for traditional pacemakers, those without any proper vascular access to the heart, those who experience recurrent pacemaker-related infections, those with tachycardia-bradycardia syndrome (heart rate fluctuates between too fast or too slow rhythms).
The battery, the pacing and sensing electrodes are all encased in a single capsule and inserted directly into the right ventricle. The pacemaker senses the natural heart rhythm and is programmed and tailored to deliver electrical impulses to the heart, when the natural heart rhythm is slow or infrequent, thus helping to steady the heartbeat.
CASE 1:
The latest generation of Leadless pacemakers- AVEIRTM was implanted for the first time in the state of Tamilnadu, in a 80-year-old with diabetes, hypertension, severe aortic stenosis, coronary artery disease, post bypass surgery, chronic obstructive lung disease, and chronic kidney disease. This patient also received a transcatheter aortic valve replacement (TAVR). For the first time in India both the implants were done at the same time.
CASE 2:
An 86-year-old lady with a frail body not capable of withstanding a conventional pacemaker received the second generation of Leadless pacemakers- the Micra-AVTM
The first generation of leadless pacemaker has capability of only ventricular pacing. The second generation has capability of synchronising ventricular pacing with atrial sensing. According to cardiologists, the latest generation of leadless pacemakers are capable of pacing both the atrium and the ventricles. One device is inserted in the right atrium and the other into the right ventricle, helping the synchronisation of atrioventricular contractions. The pumping of blood is more efficient and the cardiac functions are better. The battery longevity is also longer for the current generation. While the first and second generation of leadless pacemakers cannot be retrieved from the heart in the future, the latest generation of leadless pacemakers can be removed from the heart anytime in the future.
A leadless pacemaker includes all the necessary components in one device, which is implanted into the right ventricle to deliver electrical impulses when needed to maintain the natural heart rhythm, eliminating the requirement for leads. Leads can cause complications, including lead breakage and dislodgement and infections. The leadless pacemaker has cosmetic appeal due to the absence of a visible incision and a bump on the skin. The dual-chamber retrievable leadless pacemaker is a leap forward in cardiology, and hopefully, it will be accessible to patients and routinely implemented in the future.
Discover the frontier of cardiologic care with 1win, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy. Our expert cardiac surgeons utilise the latest technology, including leadless pacemakers, to ensure you receive the best possible treatment for heart rhythm disorders. Trust 1win for your heart health needs today.
1. What is a pacemaker? A pacemaker is a small device that sends electrical impulses to help control your heart’s rhythm, especially when it beats too slowly.
2. What are leadless pacemakers and how do they differ from traditional ones? Leadless pacemakers are tiny, wireless devices that combine the battery, pulse generator, and electrodes into one unit, eliminating the need for wires and a chest incision.
3. How do leadless pacemakers work? They are implanted directly into the right ventricle via the femoral vein. The device senses the heart’s rhythm and sends electrical impulses when the heart beats too slowly.
4. What is the procedure for implanting a leadless pacemaker? The procedure is minimally invasive, using a small incision in the groin under local anaesthesia. A catheter guides the device to the heart, where it is positioned and secured in the right ventricle.
5. What are the benefits of leadless pacemakers? Benefits include a smaller device size, no chest incision or visible scar, reduced complications (no wires to break or get displaced), shorter procedure time, and quick recovery.
6. Are there any advancements in leadless pacemaker technology? Yes, recent advancements include devices capable of synchronizing atrial and ventricular pacing, longer battery life, and the ability to be retrieved if necessary in the future.
DISCLAIMER: Discuss in detail the benefits and risks of the leadless pacemaker versus traditional pacemaker implant with your treating cardiac electrophysiologist.
1win is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
