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Leadless Pacemaker Placement

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Leadless Pacemaker Implantation - An Overview

The leadless pacemaker can make a world of difference if you need a pacemaker or have already had a traditional pacemaker implanted. This small, one-piece device is a remarkable upgrade from the conventional pacemaker that comes with a separate battery and leads.

As the name suggests, the leadless pacemakers components, such as the leads and battery, are all packed inside one device. The whole device is implanted in your heart’s right ventricle because it doesn’t require any leads to connect with your heart.

Furthermore, the leadless pacemaker is 90% smaller than the transvenous device, measuring only 1 to 1.5 inches or 3-4 centimetres. Unlike the conventional pacemaker, which is flat and oval, the leadless pacemaker is a cylindrical device, smaller than an AAA battery.

Dr. Karthigesan is one of Chennai’s leading cardiologists and electrophysiologists. He is also a Certified Cardiac Device specialist. He is the go-to person for pacemaker implantation, having performed more than 8000 procedures to date. He is also the best person to guide you about caring for your health after leadless pacemaker implantation.

A collage image of Leadless Pacemaker Implantation and the X-rays showing the position of the pacemaker after implantation.
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Leadless pacemakers of different sizes.
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Leadless Pacemaker Insertion: The Purpose

Unlike the traditional pacemaker, the leadless pacemaker is implanted directly into your right ventricle using the femoral vein transcatheter approach. Hence, there is no need for a chest incision or subcutaneous generator pocket. Dr. Karthigesan will recommend a leadless pacemaker insertion for those who have:

  • Bradycardia with symptoms
  • Bradycardia-Tachycardia syndrome
  • Atrial Fibrillation with atrioventricular block
  • Afib with slow heart rates or pauses
  • Complete heart block in elderly patients

He will also recommend the procedure for patients who require pacing some of the time.

Types of Leadless Pacemakers

  • Single-chamber leadless pacemaker
  • Dual chamber like AV leadless pacemaker

Leadless Pacemaker Implantation: Evaluative Tests

Dr. Karthigesan will recommend a leadless pacemaker implantation after reviewing your:

  • Holter monitor test
  • Cardiac event monitor
  • External Loop recorder
  • Electrocardiogram
  • Echocardiogram
  • Stress test
A picture showing the Leadless Pacemaker Implantation with labels.
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A picture showing the Leadless Pacemaker Implantation procedure.
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Leadless Pacemaker Implantation: The Procedure

  • Leadless pacemakers are placed directly into your heart to generate electrical impulses that help stimulate the ventricles to maintain an ideal heart rate.
  • After administering a local anaesthetic near your groin, a small catheter is inserted through a keyhole in your femoral vein.
  • An X-ray imaging machine is used to guide the catheter to the right spot in your heart.
  • Once the catheter is in position, the leadless pacemaker is placed in your right ventricle and secure it to your heart muscle either with nickel-titanium tines or by screwing it in place.
  • After securing the device, your doctor will check it to ensure it is securely attached to the ventricle wall.
  • The device is programmed to align it with your heart rhythm requirements.
  • Finally, the catheter is removed, and the small bruise is closed by applying mild pressure to the area.
  • Generally, the leadless pacemaker procedure takes about half an hour. However, the duration can vary depending on your body and the type of device.
Leadless Pacemaker Insertion: Before, During & After Care
  • Discuss with your doctor when to fast or stop taking medications before the procedure.
  • Arrange for a family member or friend to escort you home from the hospital.
  • Continue taking your routine medicines until your doctor advises you to stop.
  • You will receive a local anaesthetic in your groin region before the procedure begins
  • The device is checked to ensure it is properly attached to the ventricle wall and if it is programmed correctly.
  • Avoid sitting or standing. Instead, lie flat on your back with your legs straight.
  • Remain in this position for 2-6 hours to prevent bleeding at the access site.
  • Your doctor will place a sterile dressing in your groin to prevent infections.
  • You may return home after the doctor takes chest X-rays and checks your device.
  • Resume your routine after a couple of weeks post-procedure.

Leadless Pacemaker Implantation: The Benefits

  • In contrast to transvenous pacemakers and leads, leadless pacemakers eliminate a number of complications including hematoma, lead fracture and displacement, and pocket infections.
  • The leadless pacemaker do not cause visible incision scars or pacemaker pockets. It is also 90% smaller than a traditional pacemaker.
  • Because there are no wires or generators, you do not need to limit upper body activity after the implant.
  • Unlike conventional pacemakers with wires, there are no arm restrictions following implant. Hence you are allowed to drive or exercise soon after discharge.
  • There is no need for any suture removal involved in this. Also, there is no restriction in bathing as usual.
  • As soon as you are discharged, you can resume your normal routine. As usual, you can continue your daily physical activities.
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Leadless Pacemaker Implantation: The Finer Details

In leadless pacemakers, a computer chip and a small, but long-lasting battery are packaged in a battery-like case. A vein on the outer surface of the upper thigh area is used to implant the device. Unlike conventional procedures, implant procedures require no surgery, so they are considered less-invasive and do not leave surgical wounds or scarring.

In contrast to conventional pacemakers, leadless pacemakers are inserted through keyhole access from the groin without requiring a surgical incision and inserting the leads.

Compared to a conventional pacemaker, this device is much smaller. A steroid-eluting electrode and a pulse generator inside the device send pulses to the heart when they detect a rhythm problem.

There is no need for any suture removal involved in leadless pacemaker implantation. As soon as you are discharged, you can resume your normal routine. You can bath, drive, exercise and do any physical activity as usual.

A leadless pacemaker is designed to detect electrical signals from your heart. Dr. Karthigesan will customise your pacemaker to generate tiny electrical impulses when your natural impulses are insufficient.

Dr. Karthigesan will suggest leadless pacemakers if you have the following issues:

  • An Atrial Fibrillation with slow heart rates or pauses.
  • A-Fib with Atrioventricular block.
  • Bradycardia-Tachycardia syndrome ( both slow and fast heart rates)
  • Bradycardia with symptoms.
  • Intermittent pacing requirement
  • Elderly patients with AV block

A leadless pacemaker battery can last for eight to twelve years. When the battery expires, Dr. Karthigesan will suggest turning off the pacemaker and replacing it with a transvenous pacemaker.

A leadless pacemaker is designed to be retrievable. While there is currently limited practical experience with the retrieval process, theoretically, it is possible to remove the device if required.

You should immediately consult your cardiologist if you experience any of these problems:

  • Swelling around your ankles and calves
  • Infection or bleeding around the bruised site
  • Breathlessness and dizzy spells
  • Symptoms that existed before the pacemaker implantation
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