Leadless Pacemaker Technologies: Patient Selection, Approach, and Outcomes

AbstractPurpose of ReviewLeadless cardiac pacemakers have recently entered clinical use for patients requiring single ventricular chamber pacing only. Two leadless systems have been utilized, the Nanostim leadless cardiac pacemaker and the Micra transcatheter pacing system. While currently limited to only a minority of pacemaker eligible patients, technical hurdles are expected to be overcome which will allow this technology to reach a much broader population. This review discusses the patient population for which these devices are indicated, the approach to device implantation and retrieval, and ongoing data on their long-term use.Recent FindingsTwo major non-randomized clinical trials investigating the Nanostim and Micra leadless pacemaker systems were published in theNew England Journal of Medicine in 2015 and 2016, respectively, with implant success rates of the active and passive fixation devices of 95.8 and 99.2%, respectively. The Nanostim and Micra demonstrated efficacy and safety, with major complication rates of 6.7 and 4% at 6 months, respectively, comparing favorably to historical transvenous pacemaker controls. Ongoing real-world registry data from Micra shows similar results, whereas Nanostim implantations have been halted due to an unexpected battery malfunction alert in late 2016. More data on device retrieval has become available, along with other strategies for end-of-life management.SummaryLeadless pacemakers have emerged in clinical use based on their clin...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research