Overview
A leadless pacemaker is a self-contained device implanted directly into your heart without the need for leads or wires. The entire unit, roughly one-tenth the size of a traditional pacemaker, contains a battery, computer circuits, and electrodes all in one compact capsule. It measures about one inch long and weighs less than two grams.
This innovative device works just like a traditional pacemaker, monitoring your heart’s electrical activity and delivering electrical pulses when your heart beats too slowly. However, instead of being placed under the skin in your chest with wires running to your heart, the leadless pacemaker is positioned directly inside your heart.
The device attaches to your heart wall using small tines or hooks that extend from one end, much like a tiny anchor. These tines hold it securely in place while allowing the device to move naturally with your heartbeat. Because it sits inside your heart, there’s no visible bump under your skin and no wires that could break or become infected.
Single-chamber leadless pacemakers have been available for several years and are implanted in the right ventricle. More recently, dual-chamber leadless pacing systems have become available, using two separate devices that communicate wirelessly with each other. One device sits in the right atrium (upper chamber) and another in the right ventricle (lower chamber). These devices coordinate your heart’s rhythm by communicating through wireless signals, providing more natural pacing for patients who need both chambers controlled.
Your doctor will determine which type of leadless pacemaker is right for you based on your specific heart rhythm problem. The battery in these devices typically lasts eight to thirteen years, comparable to traditional pacemakers.
One significant advantage is the reduced infection risk. Traditional pacemakers have a pocket under the skin that can become infected, and the leads traveling through veins can sometimes harbor bacteria. With no pocket and no leads, leadless pacemakers eliminate these potential sites of infection.
Why You Might Need One
Leadless pacemakers treat the same heart rhythm problems as traditional pacemakers, specifically conditions where your heart beats too slowly. Advances in technology have expanded who can benefit from these devices.
You might be considered for a single-chamber leadless pacemaker if you have bradycardia, particularly if you also have atrial fibrillation. This combination is common in older adults. The device can maintain an adequate heart rate even when your heart’s natural rhythm becomes irregular and slow.
Some people develop slow heart rates as a side effect of medications needed to control atrial fibrillation. Rather than stopping these important medications, a leadless pacemaker allows you to continue them safely while maintaining a healthy heart rate.
Dual-chamber leadless pacing systems have opened new possibilities for patients who previously required traditional pacemakers. If you have sick sinus syndrome, where your heart’s natural pacemaker doesn’t work properly, or certain types of heart block where coordination between upper and lower chambers is important, you may now be a candidate for a leadless system. These newer systems provide the benefits of dual-chamber pacing without the complications associated with leads.
People who have had complications with traditional pacemakers sometimes switch to leadless devices. If you’ve experienced repeated infections of your pacemaker pocket or lead problems, a leadless pacemaker might be a better option. Similarly, if you have difficult vein access that makes threading leads challenging or impossible, the leadless approach may work better.
Younger, more active patients often prefer leadless pacemakers because there’s no visible device under the skin and no restrictions on arm movement during recovery. Athletes and people who engage in contact sports may find this particularly appealing.
Patients on dialysis or those with a history of blood infections may be better candidates for leadless pacemakers due to the lower infection risk. People who have occupations or hobbies that could damage a traditional pacemaker pocket, such as athletes who play contact sports or workers who use heavy equipment, may also benefit.
However, leadless pacemakers aren’t suitable for everyone yet. Some advanced pacing features available in traditional pacemakers aren’t currently available in leadless systems. If you need specialized features like cardiac resynchronization therapy for heart failure, a traditional device is still necessary. Your doctor will discuss which option is best for your specific condition.
Before the Procedure
Preparation for a leadless pacemaker is similar to that for a traditional pacemaker, though the procedure itself differs significantly. Your doctor will perform a thorough evaluation including an electrocardiogram, echocardiogram, and blood tests. The echocardiogram is particularly important because it shows the size and function of your heart chambers, helping your doctor determine if a leadless pacemaker will fit properly and if you need single or dual-chamber pacing.
You’ll need to inform your doctor about all medications you take. Blood thinners require special attention. Depending on which blood thinner you use and why you take it, your doctor may adjust the dose or have you stop it temporarily. Never make these changes on your own, as they could increase your risk of blood clots or bleeding.
If you have kidney disease, your doctor needs to know because the procedure uses contrast dye that can affect kidney function. You may receive extra fluids before and after the procedure to help protect your kidneys.
The night before the procedure, you’ll stop eating and drinking after midnight. You may be allowed to take certain medications with a small sip of water in the morning. Your doctor will give you specific instructions.
Unlike traditional pacemaker implantation, which is done near your collarbone, a leadless pacemaker is inserted through a vein in your groin. This means you should avoid shaving or applying lotions to your groin area on the day of the procedure, as the medical team will clean and prepare the area.
Arrange for someone to drive you home. While the procedure is less invasive than traditional pacemaker implantation, you’ll still receive sedation and shouldn’t drive for at least 24 hours afterward.
Plan to stay in the hospital overnight for observation, though some patients go home the same day. Bring comfortable, loose-fitting clothes and any personal items that help you feel at ease. If you’re receiving a dual-chamber system, the procedure may take slightly longer, but the preparation remains the same.
The Procedure
Leadless pacemaker implantation typically takes one to two hours for a single-chamber device and two to three hours for a dual-chamber system. The procedure is performed in a cardiac catheterization lab and is less invasive than traditional pacemaker surgery because there’s no incision in your chest and no pocket created under your skin.
You’ll receive medication through an IV to help you relax, along with local anesthetic at the insertion site in your groin. Most patients remain awake but drowsy during the procedure. Some hospitals offer general anesthesia if you prefer to be completely asleep.
Your doctor makes a small puncture in the femoral vein, a large vein in your groin. This puncture is much smaller than a surgical incision, usually less than a quarter inch. Through this access point, your doctor inserts a catheter, a thin flexible tube that serves as a pathway to your heart.
Using X-ray guidance, your doctor threads the catheter through your vein, up into your chest, and into the right side of your heart. The leadless pacemaker travels inside this catheter. For a single-chamber device, the catheter reaches the right ventricle. For a dual-chamber system, your doctor will implant one device in the right atrium first, then position the second device in the right ventricle.
When the catheter reaches the target location, your doctor carefully positions the pacemaker against the heart wall. The device is then deployed, meaning the small tines extend to anchor it securely to your heart muscle. Your doctor performs tests to ensure the device is positioned correctly and functioning properly. These tests measure how well the device senses your heart’s natural electrical signals and how much energy is needed to pace your heart effectively.
For dual-chamber systems, once the first device is secured, the process is repeated for the second device. The two devices are then programmed to communicate with each other wirelessly, coordinating the timing between your upper and lower heart chambers. This coordination mimics your heart’s natural rhythm more closely.
Once the device or devices are confirmed to be working properly and securely attached, the delivery catheter is removed. Pressure is applied to the puncture site in your groin to stop any bleeding. Some doctors use a closure device to seal the vein more quickly.
Throughout the procedure, you’re monitored continuously. The medical team watches your heart rhythm, blood pressure, and oxygen levels on screens. You might feel pressure in your groin when the vein is accessed and perhaps some unusual sensations in your chest when the device is being positioned, but the procedure generally causes minimal discomfort.
What to Expect During the Procedure
During the procedure, you’ll lie flat on your back on an X-ray table. The room may feel cool, but warm blankets are available. The sedation makes you feel relaxed and sleepy. You can communicate with the medical team if you feel uncomfortable.
When the local anesthetic is injected into your groin, you’ll feel a brief sting that quickly fades. As the catheter is inserted into your vein, you might feel some pressure but shouldn’t feel pain. The catheter traveling through your veins toward your heart is painless because veins don’t have pain receptors.
When the device is being positioned in your heart, some patients report feeling fluttering or unusual sensations in their chest. This is normal and temporary. As your doctor tests the device, you might feel your heart beat more strongly for a few seconds. If you’re receiving a dual-chamber system, you may experience these sensations twice as each device is positioned and tested.
The most uncomfortable part for many people is lying still on a hard table for an extended period. Your back might get stiff or sore. Let the team know if you need to shift position slightly, though you’ll need to stay relatively still during critical moments of the procedure.
If you feel anxious, take slow, deep breaths. The medical team is experienced in helping patients stay calm and comfortable. Don’t hesitate to speak up if you have concerns or feel pain.
After the Procedure
After the leadless pacemaker is implanted, you’ll move to a recovery area. The most important immediate concern is the access site in your groin. You’ll need to lie flat with your leg straight for several hours to prevent bleeding. This can feel restrictive, but it’s crucial for proper healing.
Nurses will check the site frequently, looking for signs of bleeding or swelling. You’ll have a pressure dressing over the puncture site. Some bruising in your groin area is normal and nothing to worry about.
You can eat and drink once you’re fully awake from the sedation. Most people feel well enough to eat within a few hours of the procedure. There are no dietary restrictions related to the pacemaker itself.
Before you leave the hospital, a technician will check your pacemaker using a programmer placed on your chest. This device communicates wirelessly with your pacemaker to ensure it’s working correctly. For dual-chamber systems, the technician will verify that both devices are communicating properly with each other and functioning as a coordinated unit. You’ll receive a pacemaker ID card to carry with you at all times.
Most patients stay overnight for observation, though same-day discharge is possible if everything goes smoothly. You’ll need someone to drive you home, as you shouldn’t drive for at least 24 hours after receiving sedation.
Recovery and Care at Home
Recovery from leadless pacemaker implantation is generally quicker and easier than recovery from traditional pacemaker surgery. There’s no incision on your chest that needs to heal, and you don’t have to restrict arm movement to protect leads.
The puncture site in your groin needs care for the first few days. Keep the area clean and dry. A small bruise is normal, but watch for increasing swelling, pain, or a hard lump. These could indicate a hematoma or other complication requiring medical attention.
Avoid strenuous activity for about a week. Don’t lift anything heavier than ten pounds, and avoid vigorous exercise. However, you can walk as much as you like, and gentle movement is encouraged. Most people return to normal activities within a few days to a week.
You can shower the day after the procedure, but avoid soaking in a bathtub, hot tub, or swimming pool for at least a week. When showering, let water run over the groin area but don’t scrub it vigorously.
Unlike traditional pacemakers, you don’t need to restrict shoulder and arm movement. There are no leads that could be dislodged by raising your arms overhead. This makes daily activities easier during recovery.
Your first follow-up appointment typically occurs within a month. Your doctor will check how you’re feeling and ensure the pacemaker is functioning properly. For dual-chamber systems, the doctor will also verify that the two devices continue to communicate effectively. After that, regular checkups occur every three to six months. Many doctors offer remote monitoring, where your pacemaker sends data to your doctor’s office automatically through a bedside monitor.
Living with a Leadless Pacemaker
One of the biggest advantages of a leadless pacemaker is that you can’t see or feel it. There’s no bump under your skin, and because it’s completely inside your heart, you may forget it’s even there. Whether you have a single or dual-chamber system, the devices work silently in the background.
All the precautions that apply to traditional pacemakers also apply to leadless devices. Cell phones are safe but should be kept at least six inches from where the devices are located, roughly over the center of your chest. Don’t carry your phone in a chest pocket.
Most household appliances and electronics pose no risk. Microwaves, computers, televisions, and other common devices won’t affect your pacemaker. Airport security systems may detect the device, so carry your pacemaker ID card and inform security personnel.
Many newer leadless pacemakers are MRI-conditional, meaning they’re safe for MRI scans under specific conditions. Always inform any healthcare provider about your pacemaker before any medical procedure, including dental work.
Exercise and physical activity are encouraged. Because there are no leads to worry about, you can engage in most activities without restriction once you’ve healed from the implantation. Swimming, golf, tennis, and even contact sports are generally safe, though you should discuss your specific activity plans with your doctor.
Air travel is completely safe. You can fly as soon as you feel well enough after the procedure. The cabin pressure changes don’t affect your pacemaker at all.
Sexual activity can resume when you feel comfortable, typically within a few days of the procedure. The pacemaker won’t interfere with intimacy in any way.
If you need other medical procedures or surgery in the future, make sure to inform all healthcare providers about your pacemaker. Some procedures require special precautions or monitoring.
What Happens Without a Pacemaker
The consequences of not treating slow heart rhythms are the same whether you would receive a leadless or traditional pacemaker. Without treatment, your symptoms will continue and likely worsen.
Chronic fatigue becomes debilitating. Your organs don’t receive adequate blood flow, leaving you exhausted with minimal activity. Simple daily tasks become challenging, affecting your independence and quality of life.
Dizziness and fainting episodes pose serious safety risks. Falls can result in head injuries, fractures, and other trauma. For older adults, these injuries can lead to significant complications and loss of independence. The fear of fainting can cause you to limit your activities, further reducing your quality of life.
Your heart muscle can weaken over time from chronically slow rates, potentially leading to heart failure. This condition causes shortness of breath, fluid retention, and severely limits your ability to stay active.
In severe cases, particularly with complete heart block, dangerous heart pauses can occur. Without immediate treatment, these pauses can be life-threatening. A pacemaker provides continuous protection against these dangerous rhythms.
The psychological impact is significant. Living with constant exhaustion and the fear of fainting creates anxiety and can lead to depression. Many people withdraw from social activities and hobbies they once enjoyed.
When to Call Your Doctor
Contact your doctor if you notice unusual swelling, pain, or a hard lump at the groin puncture site. While small bruises are normal, large hematomas or increasing swelling need evaluation. If the area becomes warm, red, or starts draining fluid, call immediately as these are signs of infection.
Seek emergency care for severe chest pain, especially if accompanied by shortness of breath, sweating, or pain radiating to your arm or jaw. While rare, these symptoms could indicate a serious problem.
Call your doctor if symptoms you had before getting the pacemaker return. Dizziness, fainting, unusual fatigue, or irregular heartbeats might mean the device needs adjustment or isn’t functioning properly. For dual-chamber systems, if the two devices stop communicating effectively, you may notice a return of symptoms.
If you experience persistent hiccups that don’t go away, contact your doctor. This can sometimes occur if the pacemaker’s position shifts and stimulates the diaphragm.
Pain that worsens instead of improving, or new pain that develops days or weeks after the procedure, warrants medical attention. While some discomfort is normal initially, pain should gradually decrease.
Before any medical procedure, surgery, or even dental work, inform the healthcare provider about your pacemaker. Some procedures require special precautions or monitoring.
Never skip your scheduled pacemaker checkups. These appointments are essential for monitoring battery life, checking device function, and making any necessary adjustments. For dual-chamber systems, these checkups also ensure both devices continue to communicate properly. Regular monitoring helps detect potential issues before they cause symptoms.
If you have any concerns about your pacemaker or how you’re feeling, don’t hesitate to contact your doctor’s office. It’s always better to ask about something that turns out to be minor than to ignore a potentially serious problem. Your healthcare team is there to help you live well with your pacemaker.
You may also like to read these:
Cardiac Resynchronization Therapy (CRT): Procedure, and Benefits
Implantable Cardioverter Defibrillators (ICDs)
Arrhythmias: Symptoms, Causes, and Treatment
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC10466270/
