Before Pacemakers were introduced, treatment of patients suffering from Brady-arrythmias, slow heart rhythms which may occur as a result of disease in the heart’s conduction system (such as the SA node, AV node or His-Purkinje network) was almost impossible. There was no other way by which these all problems could be tackled with a single solution. These diseases didn’t have had any answerable treatment.
Leadless pacemakers made it possible for patients with above mentioned diseases to recover and lead a life at a normal rate. Miniature leadless pacing systems that are small enough to be placed inside the heart and avoid the need for a subcutaneous pocket and leads, the weakest aspects of a traditional pacemaker. The leadless pacemaker is dime-sized, free-standing, and inserted via femoral venous access. The pacemaker is affixed to the right ventricular myocardium and released. The delivery system is then removed, and the pacemaker remains embedded in the right ventricle.
Currently, there are two systems available: the Micra (Medtronic) and the Nanostim. The Micra is fixated to the myocardium utilizing four self-expanding nitinol tines and the Nanostim contains a screw-in helix that penetrates about 1 mm into the myocardium. The leadless pacemakers have a battery longevity of ten years, which is comparable to traditional devices, and are capable of VVI or VVIR (ventricular demand pacing where only the ventricle is paced, sensed, and the pulse generator inhibits pacing output in response to a sensed ventricular event) pacing only.
Although the leadless pacemaker is a relatively new technology, the preliminary reports of long-term performance and complications are promising, including low complications, few system revisions, and stable pacing parameters. These exciting new devices are not for all patients, however, and are contraindicated in those who require dual-chamber pacing, who have existing cardiovascular implantable electronic devices, mechanical tricuspid valves, pulmonary hypertension, or inferior vena cava (IVC) filters.
Leadless pacing offers an innovative and safe alternative for cardiac pacing in patients who require single-chamber pacing while avoiding the common pitfalls of traditional transvenous pacemaker systems. Future avenues of development in this specialized area are boundless and include transforming kinetic energy from cardiac motion to fuel the pacemaker, wireless left ventricular pacing system, potentially utilizing leadless pacemakers with subcutaneous defibrillators, and the development of a leadless pacemaker with dual-chamber pacing capabilities and resynchronization therapy.
Leadless Pacemakers have revolutionized the way some of the serious heart related issues and now Brady-arrythmias and slow heart rhythms of heart beat can be treated well.
