Renowned for his expertise in conventional pacemaker implantation, Gabriel Breuer, MD stands out as the sole cardiologist and electrophysiologist in the Palm Beach county to provide leadless pacemaker installation. This innovative device, a compact self-contained unit positioned in the right ventricle of the heart, eliminates the necessity for wires, a pulse generator, or the creation of a surgical pocket on the chest – distinguishing features of a traditional wired pacemaker. As there is no pocket involved, there's also no protrusion under the skin or leads connected to the muscle bed, making the leadless model both aesthetically preferable and less likely to cause patient discomfort.

While wired pacemakers effectively regulate heart rate, leadless models address the primary causes of pacemaker-related complications that impact around 10% of patients. The extended issues associated with wired devices encompass vein blockage, lead breakage, malfunctions, tricuspid valve regurgitation, and numerous other risks associated with removal.

In contrast to the procedure for placing a conventional pacemaker, which involves threading leads through an incision in the chest using catheters to reach the heart wall, the implantation of a leadless pacemaker is conducted through a catheter inserted in the femoral vein via a small incision in the groin. Guided into position with the aid of an X-ray machine, the catheter assists in positioning the pacemaker within the right ventricle of the heart. Following meticulous testing to ensure correct attachment and programming, the catheter is withdrawn, and the incision is closed. The entire process typically lasts about 30 minutes.

Two Leadless Technologies

The concept of leadless pacemakers was initially proposed back in 1970, but it's only recently that these devices have become commercially available. Presently, there are two prominent options in the market: the Nanostim leadless pacemaker from St. Jude Medical, based in St. Paul, Minnesota, and the Micra transcatheter pacing system by Medtronic, headquartered in Minneapolis. Both are minuscule, roughly the size of a dime, and have a lifespan ranging from 7 to 10 years. However, the Nanostim is anchored to the heart with active fixation, while the Micra employs a timed fixation mechanism to attach itself to the right ventricular endocardial surface.

Gabriel Breuer, MD stands out as one of the select few cardiologists in the country specially trained in utilizing the Medtronic product, which he exclusively employs in Southern California. Unveiled in 2016, the Micra is a remarkable 93% smaller than most conventional pacemakers, approximately the size of a vitamin capsule. Its installation is less invasive and it operates as a self-contained unit.

Data from the functioning pacemaker can be transmitted to your clinic via a smartphone app. This remote monitoring feature enables Gabriel Breuer, MD to promptly identify abnormal heart rhythms and device issues, resulting in fewer hospitalizations and an improved overall quality of life.

Risks of Leadless Pacemakers

While wired pacemakers are reliable and durable, they can develop issues over time, particularly in older patients. The installation process carries risks such as potential vascular damage, bleeding, cardiac perforation, pneumothorax, and dislodgment. In the long run, these units may malfunction, lead to vein obstruction, and even result in tricuspid valve regurgitation, among other potential risks.

Although the leadless technology is promising, it's important to note that not all patients are suitable candidates for wireless devices. This innovative technology is currently only accessible to patients with slow heart rates (bradycardia) in need of single-chamber ventricular pacing (VVIR). Patients who might not be eligible for leadless pacemakers include those with:

1. Implantable cardioverter-defibrillators, as high-voltage shocks could potentially damage pacemakers.

2. Elevated right ventricular pressures due to a higher theoretical risk of embolization.

3. Mechanical tricuspid valves or inferior vena cava filters.

4. Those requiring dual-chamber pacing.

If a pacemaker is in your future, talk to Gabriel Breuer, MD about whether a leadless pacemaker is appropriate for you. Call for an appointment.