Cardiologists at Monash Health have implanted the world’s first totally leadless, physiologic pacemaker system, designed to improve cardiac function in a patient with a severe cardiomyopathy, otherwise known as heart failure.
This unique procedure has, for the first time, used two innovative medical devices to resynchronise the pumping of the heart without requiring any wires to be implanted inside the patient’s heart.
Dr Jeffrey Alison, who leads the Cardiac Rhythm Management research team at Monash Heart, is hopeful that this procedure will make it easier to treat heart failure.
“Cardiac resynchronisation therapy electrically stimulates and resynchronises the left and right ventricles of the heart, restoring a coordinated heartbeat pattern in patients with heart failure,” said Dr Alison.
“This normally requires a pacemaker connected to three permanent leads passing through veins into the heart. However, these leads can develop faults or attract infections, leading to more complicated and high-risk procedures when the leads need to be replaced.”
In contrast to transvenous systems, the ‘leadless’ devices used in this patient can be implanted directly inside the heart’s pumping chambers (ventricles) without any connecting wires.
The procedure utilises keyhole access through a vein, where an ingenious, ultrasonically activated pacemaker the size of a grain of rice was implanted in the left ventricle. Using the same access, the latest generation, leadless right ventricular pacemaker was also implanted.
Using a new synchronisation method described as ‘physiological pacing’, the right-sided device can sense and track the activity of the atrium above, where the heart’s normal rhythm originates. Working in combination, these devices will provide physiologic, cardiac resynchronisation therapy without the need for wires inside the heart.
These devices are being used as part of separate clinical trials and could be available to the general public in the near future.
