Description

The aim of implanting a leadless pacemaker is to detect cardiac bradyarrhythmias and deliver electric pulses to help regulate the heartbeat. Most leadless pacemakers deliver single-chamber right ventricular pacing, but dual-chamber systems that deliver atrial or atrioventricular (AV) pacing are also available.

The procedure is usually done under local anaesthesia in a cardiac catheterisation laboratory. Fluoroscopic guidance is needed and intracardiac echocardiography or contrast may be needed to guide implantation in the desired location in the heart chamber (right ventricle or atrium). For single-chamber leadless pacemakers, the proximal end of the leadless pacemaker is attached to a deflectable delivery catheter system and is usually inserted percutaneously through the femoral vein or a vein in the neck (jugular access) using an introducer sheath. It is then moved into the right atrium, through the tricuspid valve into the right ventricle, and positioned near the apex or lower septum. Once in place, the leadless pacemaker is securely implanted into the endocardial wall using a fixation mechanism. Electrical measurements are taken and, if satisfactory, the leadless pacemaker is released from the catheter and the catheter is removed. If the position is suboptimal, the leadless pacemaker can be detached from the endocardium and repositioned before the catheter is released.

The pacemaker delivers electrical impulses that pace the heart through an electrode at the distal end of the device. It is adjusted using an external programming system. A catheter retrieval system is used for removal and replacement of the leadless pacemaker when needed.

A dual-chamber leadless pacemaker system consists of 2 devices implanted percutaneously in a single procedure into the target chambers: one in the right atrium and another in the right ventricle.

Several different devices are available for leadless cardiac pacemaker implantation for bradyarrhythmias.