Current state of leadless pacemakers: state of the art review

ABSTRACT

Introduction: Leadless pacemakers (LPs) are the latest advancement in the field of pacing. Experience from pivotal trials and post-marketing studies has proven the feasibility and safety of these devices. The LPs obviate the need of pulse generator pocket and leads, which translates into lower incidence of lead related complications and pocket related infections. This review will summarize the existing literature on the LPs, specifically indications; implant procedure, unique situations and long- term follow up.

Areas covered: This review will summarize the results of published pivotal trials. Several multicenter studies where LP was used in the unique situations such as during concomitant AV node ablation and across bioprosthetic valve will also be discussed. An extensive search using PUBMED was performed to identify the relevant articles.

Expert commentary: The use of LPs is expanding and the published results a preferential use of such devices for patients who need single ventricle pacing. Additionally, the use of these devices in several unique situations such as patients with inferior vena cava filters, bioprosthetic tricuspid valves and concomitant atrio-ventricular nodal (AV) ablation has also been shown to be safe.

KEYWORDS:

• Leadless pacemakers
• atrial fibrillation
• AV node ablation

Article highlights box

• Leadless pacemakers are indicated for patients who need single right ventricular pacing.

• Femoral venous access should be obtained cautiously during implantation of leadless pacemaker. The large size of introducer sheath can result in vascular damage if access is not performed carefully. The delivery sheath should be advanced under fluoroscopy.

• A septal orientation of the delivery catheter should be confirmed using multiple views of fluoroscopy and radiopaque contrast. Adequate pressure on the delivery catheter to create a ‘gooseneck’ should be confirmed prior to the deployment of the LP.

• A ‘pull and hold’ test is considered adequate if at least two tines are shown to be extending during the test.

• In patients with limited femoral venous access, the internal jugular vein can be used for leadless pacemaker implantation.

• Implantation of LPs across an inferior vena cava filter and via bioprosthetic tricuspid valve is feasible and safe.

• Long-term follow-up of patients with LPs has shown adequate pacing parameters and an extremely low rate of device embolization.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.