The idea of a totally self-contained intracardiac pacemaker is not new. It was first published in the Journal of Electrocardiology in 1970. But it's become recently viable due to advances in battery technology and circuit miniaturization. The tiny device, shown here by Dr. Oesterle, is delivered directly into the patient’s right ventricle through a catheter.
Here are some of the advantages of a totally self-contained intracardiac pacemaker:
- It’s a less invasive system. No surgery is required, thus carrying a lower risk of infection.
- It’s simpler to implant, potentially exposing the patient to less radiation during implant. (It is implanted through the femoral vein.)
- Fewer acute and chronic complications (such as infection and skin erosion).
- Better patient aesthetics, since no surgical pocket is needed for the generator.
- Lower cost and reduced length of hospital stay.
- And best of all, there are no leads to fail. Leads are—arguably—the weakest link in a permanent pacing system.
- Larger diameter catheters are needed for implantation (increased risk).
- Multiple-chamber pacing is more complex.
- There are longevity limitations.
- It's difficult to be explanted or repositioned.
- Must be abandoned at end of service (instead of replaced)
Now here comes the even better part of the story. The device will be capable of communicating wirelessly with a nearby smartphone.
This signals the direction we’re heading regarding connectivity where data can be gathered by the device and be communicated to a smartphone for either the patient or the physician to act upon as needed.
It might still be three to five years before the leadless pacemaker hits the U.S. market, assuming it gets FDA approval and achieves market accceptance. But it represents, in my view, a significant step in the right direction.
One thing is for sure: it looks like Medtronic might be listening when we ask for real-time access to the data in our implantable devices.