Dr. M Sudhakar Rao, Consultant – Cardiology, Manipal Hospital, Sarjapur Road

What is a pacemaker and what are the indications to implant?

A pacemaker is a small, battery-powered device that prevents the heart from beating too slowly. You need surgery to get a pacemaker. The device is placed under the skin near the collarbone. You may need a pacemaker if you have a slow heartbeat that lasts for a long time (multiple reasons may cause it). The conventional pacemakers called as single or dual chamber pacemakers have one to two wires or leads and are placed in one or more of heart chambers called as right atrium and right ventricle. The wires send the electrical signals needed to correct an irregular or slower heartbeat. Some newer pacemakers don’t need leads. These devices are called leadless pacemakers.

What’s the advantage and whom do we implant leadless pacemakers?

Leadless pacemakers represent a profound revolution and a significant conceptual transition. The implantation of leadless pacemakers is characterized by substantial procedural success rates and low complication rates. Unlike conventional pacemakers, this leadless pacemaker eliminates the need for chest incisions, generator pockets, or insulated wires. Instead, the device is implanted directly into the heart’s right ventricle, thereby reducing the risk of infections, lead dislodgement, lead fractures and other complications. The next-generation technology offers a minimally invasive and safer alternative to traditional pacemakers, particularly for patients with complex medical conditions like very elderly individuals, people on haemodialysis, individuals who have the need for pacemaker but have active infections ,people on strong blood thinners where chances of pacemaker site bleeding is high , people with severe leakage in tricuspid valve or valve dysfunction or people who have blocked subclavian veins( no access for conventional pacemakers).

Are there any disadvantages or side effects of leadless pacemakers?

Apart from its cost, lead-less pacemakers do not have any others differences from traditional pacemakers. Complications like dislodgement and perforations are very low and are low compared to traditional pacemakers. As they provide only single chamber ventricular pacing, they are inappropriate for patients who require dual-chamber pacing, such as patients with certain forms of heart block or sinus node dysfunction. Once the future capability for dual chamber lead-less pacemakers is realised then definitely most of pacemaker needing patients could be benefitted.