Current state of leadless pacemakers: state of the art review

Afzal, Muhammad R.; Shah, Nupur; Daoud, Georges; Houmsse, Mahmoud

doi:10.1080/14779072.2019.1664288

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…Despite advancements in lead design and operator training/experience, the incidence of lead‐related complications with transvenous cardiac implantable electronic device (CIED) implantation varies between 3% and 6% 1–6 . A desire to avoid transvenous lead‐related complications has led to development of a leadless pacemaker and the subcutaneous implantable cardioverter‐defibrillator (ICD) 7–9 . Nevertheless, transvenous CIEDs continue to comprise the majority of device implantations due to the need for dual‐chamber pacing, antitachycardia pacing, or cardiac resynchronization therapy (CRT).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation

Chandler

Apte

Ranka

et al. 2021

Cardiovasc electrophysiol

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Introduction Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized. Methods and Results This is a retrospective, age and sex‐matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m2, 15% right‐sided, 43% implantable cardioverter‐defibrillator, 15% upgrades). UGAVA was successful in 178/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38 ± 6 vs. 28 ± 6 kg/m2, p < .0001). Median time from local anesthetic to completion of UGAVA was 7 min (interquartile range [IQR]: 4–10) and median procedure time 61 min (IQR: 50–92). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6 min; IQR: 2–5 vs. 4–9; p < .001). Thirty‐day complications were similar in UGAVA versus conventional (n = 7 vs. 26, 4 vs. 7%; p = .13, p = .41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (n = 0 vs. 3, 0 vs. 1%; p = .22). Conclusions UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.

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Section: Introductionmentioning

confidence: 99%

Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation

Chandler

Apte

Ranka

et al. 2021

Cardiovasc electrophysiol

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“…This may result in difficulty in retrieving these devices after that period, although successful device extractions have still been reported even after one year post implantation [ 44 ]. This same limitation might be a great advantage of these devices, as it may explain the fact that there are almost no infections that are associated with these devices [ 45 , 46 ]. This is probably related to their miniaturized volume, continuous movement with the heart (preventing bacteria from adhering), and their incorporation within the cardiac wall, whereby there is no longer exposure of a metallic material to the bloodstream.…”

Section: Leadless Ppmmentioning

confidence: 99%

Cardiac Implantable Electronic Miniaturized and Micro Devices

Rav

Soifer²,

Hasin

2020

Micromachines

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Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities (‘arrhythmias’), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert for early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients’ life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and the termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and the survival of HF patients. Traditionally, these devices are implanted via the venous system (‘endovascular’) using conductors (‘endovascular leads/electrodes’) that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection resulting from the lifelong exposure of these leads to bacteria within the venous system. One of the important cardiac innovations in the last decade was the development of a leadless PPM functioning without venous leads, thus circumventing most endovascular PPM-related problems. Leadless PPM’s consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, directly implanted into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM’s sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices that are designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development. Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities (‘arrhythmias’), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients’ life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and survival of HF patients. Traditionally, these devices are implanted via the venous system (‘endovascular’) using conductors (‘endovascular leads/electrodes’) that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection that result from the lifelong exposure of these leads to bacteria within the venous system. The development of a leadless PPM functioning without venous leads was one of the important cardiac innovations in the last decade, thus circumventing most endovascular PPM-related problems. Leadless PPM’s consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, implanted directly into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM’s sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development.

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Current state of leadless pacemakers: state of the art review

Cited by 2 publications

References 26 publications

Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation

Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation

Cardiac Implantable Electronic Miniaturized and Micro Devices

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