NEW ERA OF PACEMAKER IMPLANTATION, LARGE TO SMALL SIZE AND PACING LEADS TO LEADLESS PACEMAKER

With advances in technology, size was reduced significantly to allow the first implantable pacemaker; however, it is now more than 50 years since transvenous leads were developed and first used with implantable devices . These early pacemakers had very limited functionality and only performed asynchronous pacing. Rapid advances have been made over the past five decades, including dual-chamber pacing, rate response algorithms, remote control devices, improved battery technology and cardiac resynchronisation therapy. Pacemaker leads, which connect the chest wall of a pacemaker to the pacing electrode in the heart, are the weakest part of pacing systems, often necessitating their risky removal and replacement. In addition, transvenous leads provide a portal into the vascular space, which increases the risk of infection. Patients with traditional pacemakers are also susceptible to haematomas and pocket infections in the chest wall where the generators lie. Thus, a self-contained leadless pacemaker which can be placed directly into the heart is an appealing prospect. All of these possibilities point towards a bright future for leadless pacing with the likely possibility that the devices of the future will be largely devoid of intravascular leads.