Leadless Pacemaker Implantation

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles).

Pacemakers are used to treat patients with bradycardia arrhythmia, slow heart rhythms that may occur due to disease in the heart’s conduction system (such as the SA node, AV node, or His-Purkinje network).

A leadless pacemaker is a small self-contained device that is inserted in the right ventricle of the heart. It does not require connecting leads (wires) or a generator or creating a surgical pocket on the chest. These are the most common causes of traditional pacemaker complications over the long term and may affect up to one in ten patients.

When the leadless device is in place, there is no lump under the skin on the chest or leads anchored to the muscle bed. Sometimes these cause minor discomfort for patients who live with traditional pacemakers. The incisional access for a traditional pacemaker and each generator replacement leaves a scar that is a cosmetic concern for some patients.

The procedure uses a catheter to place the device. The procedure typically takes less time than a traditional pacemaker implant procedure. Because there are no wires or generators, you do not need to limit upper body activity after the implant.

Why choose Presbyterian for your leadless pacemaker implantation?

Presbyterian Heart and Vascular Care has a skilled electrophysiology team who can provide a wide range of cardiac rhythm treatments. Their electrophysiology cardiologists are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and the opportunity to recover at home.

Who is eligible for a leadless pacemaker implantation?

A leadless pacemaker is only available for patients with certain medical conditions and a slow heart rate (bradycardia) who need single-chamber pacing only. Your doctor can tell you if you are a candidate for a leadless pacemaker after reviewing your medical history, heart rhythm, and the results of medical tests.

You may need one or more of these tests to diagnose whether you need a leadless pacemaker:

• Echocardiogram: This test uses sound waves (echoes) from your heart to a machine that uses the wave patterns to compose images of your heartbeat on a monitor.
• Electrocardiogram (EKG): Sensor pads with wires attached, called electrodes, are placed on your chest to measure your heart's electrical impulses.
• Stress test: Some heart problems are only evident during exercise. For a stress test, an electrocardiogram is taken before and immediately after exercise.
• Holter monitoring: This is a portable version of an EKG. It's useful in testing rhythm changes that happen at any time of day or night. You wear the monitor, and it records your heart activity as you live your life.

What conditions can be treated with a leadless pacemaker implantation?

Some abnormal heart rate conditions that require a pacemaker include:

• Bradycardia: This is when the sinus node (SA node) in your heart causes the heart to beat too slowly.
• Tachy-brady syndrome: This is when your heart alternates between fast and slow heartbeats.
• Heart block: This happens when the electrical signal is delayed or blocked after leaving the SA node.
• Fainting spells (syncope): Syncope is a temporary loss of consciousness when there is not enough blood flow to the brain. It usually happens when blood pressure is too low (hypotension).
• Heart failure: A pacemaker for people with heart failure can pump more blood to the body and help them live longer.
• Hypertrophic cardiomyopathy: This is when the heart muscle becomes thick, making it hard for the heart to pump.

How do I prepare for a leadless pacemaker implantation?

Before the procedure:

• Tell your doctor if you are allergic to any medications.
• You should not eat the night and morning before the procedure.
• Tell your doctor of any medications and supplements that you are taking.
• Tell your doctor if you have heart valve disease or a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.
• Your doctor may want you to get a blood test before the procedure to determine how long it takes your blood to clot.
• You may receive a sedative before the procedure to help you relax.
• You will likely spend at least one night in the hospital after the surgery to ensure the pacemaker works.

What should I expect during my leadless pacemaker implantation?

The leadless pacemaker is put in place using a long, thin tube called a catheter. The catheter is inserted into the femoral vein through a very small incision in your groin. Your doctor will numb this area with a local anesthetic (pain-relieving medication). Your doctor will use an X-ray machine to guide the catheter to your heart.

Once the catheter is inside the right ventricle, your doctor will place the pacemaker into position in the heart. The device is tested to make sure it is attached to the wall and programmed correctly. Then, the catheter is removed, and the incision site is closed by applying pressure to the area.

The procedure takes about 30 minutes to complete, although this can vary patient-to-patient based on individual anatomical differences.

You will need to lie flat and keep the leg straight for two to six hours after the procedure. This prevents bleeding from the access site. Do not try to sit or stand. A sterile dressing will be placed on your groin area to protect it from infection. You will spend the night in the hospital and will be able to go home after a device check and chest X-ray.

How do I care for myself after my leadless pacemaker implantation?

You may feel discomfort at the device implant site during the first 48 hours after the procedure. The doctor will tell you what medications you can take for pain relief. Call your doctor or nurse if you are in pain.

Keep the area where the device was implanted clean and dry. Do not scrub the area. Bandages may be removed three weeks after the date of the implant. Do not cover the wound unless you have been instructed to do so. Do not use creams, lotions, or ointments on the wound site.

Call your doctor if you notice:

• Increased drainage, bleeding, or oozing from the insertion site
• Increased opening of the incision where the device was implanted
• Redness, swelling, or warmth around the device insertion site
• Fever.

You may take a shower five days after the procedure.

If the device was implanted in your abdomen, do not wear tight-fitting clothing or belts.