Leadless pacemakers represent a major advancement in treating arrhythmias. Unlike traditional pacemakers, which rely on flexible leads prone to dislodgement, breakage, and infection, leadless pacemakers eliminate these risks with a compact, self-contained design implanted directly into the heart’s ventricle. About the size of a AAA battery, these devices use biocompatible titanium casings and can sense and regulate heart rhythms without the need for external wires. They are safer, cause less discomfort, and involve a minimally invasive implantation process. Currently available in single and dual-chamber versions, leadless pacemakers offer reduced complications and improved patient mobility. Although their lifespan is limited by battery life (about 15 years), innovations like energy-harvesting technology from the heart’s pumping motion are being explored. Future developments aim to expand dual chamber pacing capabilities and integrate defibrillation functions, promising greater improvements in patient care and quality of life.
Leadless Pacemakers are the next generation of implantable, self-contained biomedical devices used to maintain regular heart rhythms in patients with arrhythmia. Pacemaker technology has improved a lot since its launch in the 1950s. The tech has benefitted immensely from improvements in generator technology, miniaturization of electronics and increase in battery life. Having said that, the “Achilles heel” of the Conventional Pacemaker has always been the flexible, insulated electrodes called “Leads”. The leads are the conductors that transmit electrical signals to the heart muscle, correcting the patient’s irregular heartbeat. These leads tend to become dislodged easily and could also crack or break after implantation. There is also a risk of insulation failure. Leadless Pacemaker technology was developed to override these weaknesses. Breakthroughs in biomedical engineering have helped create a pacemaker without external leads, which is small enough to be implanted in the right ventricle of the heart. The leadless pacemakers have a lower rate of complication – This includes lead faults and infections.
The leadless pacemaker device is small and compact. It measures about 3 to 4cm long and is cylindrical. Most leadless pacemakers are smaller than AAA battery. Leadless pacemakers are available in 2 variants – single chamber and dual chamber. Single chamber leadless pacemakers only work on muscles of one of the ventricles. Dual chamber pacemakers can pace both an atrium and a ventricle. The dual chamber pacemaker is made up of 2 cylindrical pacers that communicate with each other using high-frequency pulses, to maintain regular heartbeats. The type of leadless pacemaker implanted depends on the type of arrhythmia the patient has.
The leadless pacemaker device is essentially a small computer, with a lithium battery. The outer cylinder is usually made of titanium. The titanium does a good job of protecting the electronics inside the device and is biocompatible. This makes it suitable for long-term implantation. The device can sense the patient’s heart’s electrical signals and provide additional electrical impulses to strengthen it when needed. This is done through a signal processing module, connected to an output amplifier and a pacing module.
Implantation of Leadless Pacemaker in a middle-aged patient: An ultra-short case study
Traditional Pacemakers have been the standard mode of treatment for patients with arrhythmias. However, they often resulted in complications. The electrodes or leads had to be wired to the heart muscle from an external battery. The leads would often get dislodged with movement or break when bent. The leads could also puncture surrounding tissue and cause damage. Infections in the surgical incisions needed to implant the device were also common. The leadless pacemaker is safer than conventional pacemakers in the following ways.
Leadless design – The absence of independent leads or electrodes eliminates the possibility of a number of complications – dislodged leads, broken leads or punctured lungs when the leads become dislodged. The patient has fewer restrictions in movement, and a reduced risk of infections.
No Skin Pocket – Conventional Pacemakers need a pocket beneath the skin where the battery pack is stored. This pocket has a tendency to develop an infection. The leadless pacemaker eliminates this risk too. The patient will not be able to feel a leadless pacemaker under their skin or experience any physical discomfort while moving around.
Small size – The compact shape and size of the leadless pacemaker has many benefits. First and foremost, the small size of the leadless pacemaker allows it to be housed within the ventricle. The device can be implanted through a minimally invasive catheter procedure. A very small incision is all that’s needed to accomplish this. The entire procedure can be finished in 30 minutes. A smaller incision has lower chances of becoming infected. The patient also suffers minimal scarring.
Leadless pacemakers are durable and are estimated to have a lifespan of almost 15 years. At present, battery lifespan is our limiting factor, so when the battery life runs out, the pacemaker has to be replaced. The doctor may choose to deactivate the old leadless pacemaker and leave it in place, or remove it. A new leadless pacemaker can be placed while the inactive old pacemaker is still in place. Since the device is so small, there is enough space in the right ventricle. The doctor will take the final call on whether to remove the old pacemaker or not, depending on the individual patient’s risk factors.
Leadless pacemakers, as an innovative concept, have revolutionized the industry. Having said that, the innovation is just starting. Dual-chamber sensing technology, that can sense the vibrations from the atrium and ventricle simultaneously and adjust the pace of the heart, accordingly, is now being developed by leading biotech companies. Leadless dual-chamber pacing is also being tested and refined for roll-out to more patients. Dual-chamber pacing will become a game changer for patients who require atrial and ventricular pacing. Combining existing leadless pacemaker technology with subcutaneous ICD technology is also being explored. This would allow the device to not only maintain pace but also provide a life-saving electrical pulse to the heart in case of sudden cardiac arrest.
Batteries have been identified as one of the limitations of leadless pacemaker technology. The lifespan of battery technology decides how long a patient can use the pacemaker. Scientists have now been asking – What if we can power the pacemaker with the patient’s heartbeat? This out-of-the-box idea has gained traction and is currently being tested in live pigs. The results so far have been encouraging – A wafer-sized generator is attached to the heart, converting the mechanical energy from pumping into electrical energy, which is then stored in a capacitor. The field of cardiac devices has had a profound impact on patient’s quality of life, and research in this field continues to progress in that direction. Leadless cardiac pacemakers are a solid start – We are hopeful of growth and improvement in this field over the coming decades.
Leadless pacemakers mark a revolutionary step in modern cardiac care. They reduce complications related to wires, infections, and movement restrictions common in conventional pacemakers. With a compact, self-contained structure, they ensure smoother implantation, faster recovery, and long-term heart rhythm stability.
If you’re exploring comprehensive diagnosis and treatment of arrhythmias, advanced leadless pacemaker implantation may be the right choice. Consult your cardiologist to learn if this minimally invasive technology suits your heart’s specific needs.
A leadless pacemaker is a small, self-contained device implanted directly into the heart’s ventricle to regulate heartbeat without external wires or leads. It provides electrical pulses to correct irregular heart rhythms and reduces the risk of complications common with traditional pacemakers.
It senses the heart’s natural rhythm and delivers electrical impulses only when needed. The device is powered by a long-lasting lithium battery and communicates wirelessly with medical devices for monitoring.
A leadless pacemaker works without wires or a chest pocket, reducing risks like infection or dislodgement and offering faster recovery.
Most leadless pacemakers have a battery life of up to 15 years. When the battery depletes, a new device can be implanted while leaving the old one safely in place.
Future designs aim to include dual-chamber pacing, integrated defibrillation, and even self-charging from the heart’s own motion — promising longer life and smarter heart care.
Patients with specific arrhythmias who need pacing in one or both chambers of the heart may qualify after evaluation.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Vadapalani & Radial Road), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Chennai Radial Road – 044 40504050 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011
