Leadless pacemakers: leading us into the future?

Abstract

This editorial refers to ‘Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study’, by P. Ritter et al ., doi:10.1093/eurheartj/ehv214. If at first the idea is not absurd, then there will be no hope for it.A. Einstein Since the first permanent pacemaker implant, almost 60 years ago, there has been continued progress and evolution of these devices. The technology has advanced on many fronts, with longer battery lives, smaller sized generators, with an intelligent ‘adaptive functionality’ closely mimicking the human physiology. However, contemporary implant technology has been disadvantaged by the need for a subcutaneous implantable device (with a risk for infection or erosion) and an attached pacing electrode system within the cardiac vasculature that itself is at risk for fracture and infection. The additional hazard of extracting malfunctioning or infected leads poses further challenges. Notably, almost 10% of the ∼700 000 pacemakers implanted annually worldwide are associated with lead-related problems.1,2 This, in turn, has created the need for a leadless pacemaker system. Although Spickler et al . first reported the theory of a totally self-contained leadless intracardiac pacemaker in 1970,3 it is only through recent technological advancements in battery energy, endocardial fixation, and delivery systems that this concept has become a reality. The leadless device not only has improved the aesthetics of an implant through eliminating the visible lump and scar of a conventional pectoral pacemaker implant but also has potentially reduced the risk of complications, related to infections and lead …