In an evolution of medical technology that dates to the 1950s, pacemakers that contain no lead components and are less intrusive than earlier versions are on the market.
This year marked the introduction of the atrial leadless pacemaker, which like those that came before it uses electrical impulses to regulate slow or erratic heartbeats.
Dr. Steven Ross, a clinical cardiac electrophysiologist at Baptist Medical Center, said the new technology allows for two leadless units to be inserted, one in the top right chamber and the other in the lower left chamber, to better control and monitor heart function.
This arrangement is different from the original pacemakers, which comprised a battery pack with two wires, known as leads, that were attached to the heart’s upper right chamber and the left lower chamber. The pacemaker was inserted through a 3 to 4-centimeter incision in the chest.
Ross said the new technology has several advantages over the original versions and a less invasive, wireless type that has been on the market for about 10 years.
The two leadless pacemakers can “communicate” with each other to better regulate the heart, he said. That connection, he said, resembles how a normal heartbeat would function.
“The normal rhythm really is reliant upon the upper chambers to tell the bottom chambers when to beat. The bottom chambers just sort of follow along. And so the ability to implant these devices in the upper chamber of the heart and function as a traditional pacemaker system is a big advantage,” Ross said.
Smaller than a AA battery and inserted using a catheter through a tiny incision in the groin, the leadless pacemaker offers a reduced chance of infection, fewer complications related to vein scarring and better compatibility for patients on dialysis.
There is also a practical matter of how the implant looks. The battery pack in early pacemakers formed a noticeable lump on the chest. Not so for the new technology.
“Younger patients, who are worried about those sort of aesthetic implications, like them because you can’t really see a leadless pacemaker. So that’s an advantage,” Ross said.
The traditional pacemaker operation can last from 60 to 90 minutes, with the patient placed under deep sedation or general anesthesia.
“For a leadless pacemaker, I would say, from start to finish, it probably takes about 30 minutes,” Ross said.
“So it’s a shorter procedure. It saves some time. And obviously, the less time you’re under anesthesia, the less time for a procedure, usually the better off you are.”
Reduced recovery time is another benefit.
After the traditional pacemaker operation, the patient’s use of the right arm is limited for more than a month.
Leadless pacemakers allow for a much quicker recovery time, Ross said.
When two leadless pacemakers are inserted, the battery life is from six to seven years, he said. While the battery in the wired pacemaker may last up to 10 years, replacing the battery involves making an incision and removing the pacemaker to insert a new battery.
With the leadless model, the original procedure is also repeated. The old one can be removed and replaced. Because they are so small, another option is to leave the original in place and insert a new one beside it, Ross said.