Dr Abhishek Mohanty| All you need to know about Leadless Pacemaker| Continental Hospitals

Pacemakers are devices used for increasing the heart rate. It is used for the treatment of a person who has been diagnosed with an abnormally low heart rate.

The conventional pacemaker of the heart consisted of a pulse generator and leads (wires). The leads are introduced through the veins and attached to one or two chambers of the heart. The pulse generator is attached to the leads and placed in a surgical pocket on the chest.

Leadless pacemakers do not require leads or a generator. It is a minuscule version of a pacemaker. The procedure uses a catheter to introduce the place of the device.

What are the benefits of a leadless pacemaker?

  • When we use a leadless pacemaker, there will not be any lump within the skin of the chest. The creation of the pocket while introducing a traditional pacemaker may create a scar which may be a cosmetic concern for some patients. This issue does not arise with a leadless pacemaker since it does not require any incision.
  • The procedure typically takes less time than a traditional pacemaker implant procedure. Also, the patient can go home earlier.
  • After implantation of traditional hearts pacemaker implantation, it is usually advised to restrict the shoulder movement for a few weeks. It can result in shoulder pain and frozen shoulder, especially in elderly and diabetic persons. Such an issue can be avoided by using a leadless pacemaker since normal mobility can be allowed after a few hours of the procedure.

Who is a candidate for a leadless pacemaker?

Every patient with an abnormal heart rhythm is not a candidate for a leadless pacemaker. Currently, the device is available only for patients with certain medical conditions which require single-chamber pacing only. The second generation of leadless pacemakers can mimic the natural pacing system of the heart.

 

PROCEDURE DETAILS

How is the leadless pacemaker implanted?

The leadless pacemaker is implanted in a chamber of the heart called the right ventricle using a long, thin tube called a catheter which is inserted through a vein in your groin. The procedure is done under local anaesthesia. It takes roughly 30-40 minutes to complete the procedure.

The procedure is done under X-ray guidance. The device is tested to make sure it is attached to the wall and programmed correctly. Then, the catheter is removed and the incision site is closed by applying pressure to the area.

What are the risks of a leadless pacemaker implant?

Leadless pacemakers were developed to overcome pocket- and lead-related complications. Results from multiple studies have demonstrated a high implantation success rate and a low major complication rate, with a >60% reduction in complications versus transvenous pacemakers.

It is generally considered a safe procedure. Rarely access site bleeding and swelling can happen. It is also extremely rare for the device to get dislodged or result in the collection of fluid outside the heart.

CASE HISTORY: Leadless Pacemaker Implant

An 85-year gentleman presented to us with a complaint of recurrent episodes of blackout for a few years resulting in injuries. It used to happen roughly 4-5 times every year. Otherwise, he was mentally sound and does all his activities independently.

He had undergone coronary artery bypass surgery in the year 2011 with preserved heart function to date.

After a thorough evaluation, he was diagnosed with a case of abnormal heart rhythm which was intermittently used to reduce his heart rate to a very low level resulting in blackouts. As the only treatment option, he was advised to have a pacemaker implanted.

Considering his age and fragile body, he was unwilling to implantation of a routine pacemaker which required us to create a chest pocket to lodge it. Hence a minimally invasive leadless pacemaker implantation was suggested to him. It was done successfully within 30 minutes without any complications. He was mobilised after 4 hours and was discharged the very next day.

Heart

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