Single‐chamber leadless pacemaker for atrial synchronous or ventricular pacing

Abstract

Leadless pacing is a major breakthrough in the management of bradyarrhythmia. Results of initial clinical trials that have demonstrated a significant reduction in acute and long‐term pacing‐related complications have been confirmed by real‐world experience in a broader spectrum of patients. Nonetheless current use of a leadless pacemaker is hampered by its limited atrial sensing and pacing capability, as well as battery life‐span and retrievability. We review the current clinical outcome data, indications and contraindications, implantation and retrieval techniques, synchronous ventricular pacing, and other clinical considerations. We also provide an overview of the latest advancements in leadless pacing technology including device‐to‐device communication and energy harvesting technology.

Pacing induced tricuspid regurgitation: Does the lead matter?

“…The relative importance of these mechanistic effects on TR remains uncertain. Leadless pacing (LPM) avoids the need for a lead passing through the TV 6–8 . However, given the bulkiness of the LPM and imperfect AV synchrony in some current devices, it remains uncertain if LPM can mitigate all the above adverse effects of pacing on TR (Figure 1).…”

Inappropriate rate response in a leadless pacemaker due to automatic rate profile optimization

“…Rate response occurs if accelerometer counts (AC) exceed the setpoint value at the LR, and increases with increasing counts to the programmed ADLR and then to the UR. 1 Automatic rate profile optimization (RPO) allows automatic changes to improve rate adaptation. 2 The setpoints for the LR, ADLR, and UR are automatically adjusted on a daily basis in steps to achieve a population based long term target rate profile.…”

Association of leadless pacing with ventricular and valvular function

“…Leadless pacemakers are increasingly being used in clinical practice for the treatment of bradycardia and conduction disorders, especially in patients with chronic atrial fibrillation, those at increased risk of transvenous pacemaker infection, or those who require infrequent pacing. 1 Leadless pacemakers have several advantages over traditional transvenous pacemakers in that they do not require a surgical pocket or transvenous leads, and the surface area of intravascular hardware is significantly reduced. 2 Traditional transvenous pacemakers are associated with worsening tricuspid valve (TV) function and need for TV surgery due to pacing leads placed across tricuspid valve.…”