17166 Pacemakers Leadless Pacemaker

Overview

A leadless pacemaker is a very small, self-contained device — about the size of a large vitamin capsule — that is placed directly inside the lower right chamber of your heart. Like a traditional pacemaker, it sends tiny electrical signals to keep your heart beating at a safe rate when your heart's natural rhythm is too slow. The big difference is that it has no wires (doctors call them leads) and no pocket under the skin of your chest. The whole device sits inside the heart, so there is nothing visible on the outside of your body.

Leadless pacemakers are newer than traditional pacemakers and are used less often, but they are becoming more common. Most people who need a pacemaker still receive a traditional one with leads and a small chest pocket. Your heart team will recommend the type that best fits your heart rhythm problem, your veins and your overall health.

Leadless pacemakers are used for people whose heart beats too slowly (a condition called bradycardia) and who need pacing in one chamber of the heart. This includes some older adults, people who have had problems such as infection with traditional pacemaker leads, people whose veins make a traditional implant difficult, and some people with other serious illnesses where a simpler procedure is safer. They are only occasionally used in children, usually in specialist centres.

Symptoms

Common symptoms

• Feeling very tired or having much less energy than usual
• Dizziness or light-headedness, especially when standing up
• Fainting or nearly fainting (blackouts)
• Shortness of breath with mild activity
• A slow, regular heartbeat that you can feel, or a fluttering feeling in the chest
• Feeling confused, foggy or 'not yourself', especially in older people
• Chest discomfort or a sense of the heart pausing or missing beats

Symptoms in children

• Poor feeding, slow weight gain or unusual sleepiness in babies
• Tiring quickly during play or sport compared with other children
• Fainting or dizzy spells
• Learning or concentration difficulties linked to a very slow heartbeat
• Note: slow heart rhythms needing a pacemaker are uncommon in children and are usually assessed by a children's heart specialist

Symptoms in older adults

• Unexplained falls or unsteadiness
• Memory problems or confusion that come and go
• A general 'slowing down' or loss of stamina
• Fainting that may be blamed on other causes
• Breathlessness doing everyday tasks like dressing or walking to the shops

Causes

Main causes

• Wear and tear on the heart's natural pacemaker (the sinus node), often simply due to getting older
• Heart block — a delay or block in the electrical signals travelling between the upper and lower chambers of the heart
• Damage to the heart muscle from a heart attack or long-standing coronary artery disease
• Heart valve disease or heart failure affecting the heart's electrical system
• Complications of heart surgery, or inflammation or infection of the heart
• Some medicines that slow the heartbeat, when they are needed for another condition
• Inherited (genetic) heart rhythm conditions, and rarely, problems with the body's salt balance or an underactive thyroid

Risk factors

• Increasing age
• A previous heart attack or known coronary artery disease
• High blood pressure, high cholesterol or diabetes
• Heart valve problems, heart failure or previous heart surgery
• A family history of heart rhythm problems or early pacemaker use
• Taking medicines that slow the heart rate
• Some autoimmune or inflammatory conditions that can affect the heart

When to see a doctor

See a doctor urgently if:

• You have fainted or had a blackout — do not drive yourself, get help
• Dizziness, breathlessness or tiredness that is quickly getting worse
• Signs of infection after a procedure: fever, chills, or redness and swelling where the catheter went in
• Your heartbeat feels very fast, very slow or uneven, and you feel unwell with it

Book a routine appointment if:

• You have noticed your heartbeat is slower than usual and you feel more tired than you used to
• You have occasional dizzy spells you can't explain
• You have been told you have a slow heart rhythm and want to talk about options
• You have a pacemaker and are due for a check, or you notice new symptoms
• You are planning travel, an MRI, or another medical procedure and want advice about your device

Diagnosis

Your doctor will start by asking about your symptoms, your medicines and your family history, and will examine you, checking your pulse and heart. The key test is an electrocardiogram (ECG), which records the heart's electrical signals through sticky patches on your chest. Because slow rhythms can come and go, you may also be given a portable monitor to wear at home for a day or longer. If tests show your heart beats too slowly and this fits your symptoms, your doctor will refer you to a heart specialist (cardiologist) to discuss whether a pacemaker would help, and which type.

Tests that may be done

• Electrocardiogram (ECG) — a painless recording of your heart's electrical activity
• Ambulatory (portable) ECG monitor — worn for 24 hours, several days, or longer, to catch a slow rhythm at home
• Implantable loop recorder — a small device under the skin that records the heart rhythm for months, used in some cases
• Echocardiogram — an ultrasound scan showing the heart's structure and how well it pumps
• Blood tests — to check thyroid, salt levels and other causes of a slow heartbeat
• Exercise or tilt-table tests in selected people
• Electrophysiology study — a specialist test that maps the heart's electrical pathways, used only when needed

What to expect at your appointment

Most tests are quick and painless. You may be asked to avoid caffeine before an ECG, and to keep a diary of symptoms while wearing a home monitor. Results usually come back within days to a few weeks. If a pacemaker is being considered, you will have a conversation with the heart team about the benefits, the risks, the type of device, and what the procedure involves, so you can decide together.

Treatment

Treatment aims to stop your heart beating too slowly so your body gets the blood and oxygen it needs. If a slow heartbeat is caused by a medicine, your doctor may adjust it. If the cause is a problem with the heart's own electrical system and you have symptoms, a pacemaker is usually the best solution. A leadless pacemaker is one option; a traditional pacemaker with leads is another. The right choice depends on your heart rhythm problem, your veins, your other health conditions and your preferences.

Self-care at home

• Keep all follow-up appointments and device checks — these are usually simple and painless
• Follow your care team's instructions about wound care and how long to avoid heavy lifting or vigorous activity after the procedure
• Carry your device identification card, and tell any doctor, dentist or nurse that you have a pacemaker
• Ask your team about safe distances for keeping a mobile phone or headphones away from your chest, and about magnets and strong magnetic fields
• Check before any MRI, diathermy, or electrical treatment, and before certain medical procedures, so precautions can be planned
• Tell airport security staff you have a pacemaker — you can usually be checked by hand instead of walking through the scanner
• Keep active, eat a balanced diet, and manage blood pressure and cholesterol as advised

Medical treatments

There are no medicines that reliably speed up a slow heart rhythm in the long term, so the main treatment is a device. Two main types are used. A traditional pacemaker sits under the skin of the chest with thin wires threaded into the heart. A leadless pacemaker is a single small capsule placed directly inside the heart through a vein, with no wires and no chest pocket. Some people also need a device that paces more than one chamber, which a leadless device may not be able to do. Your heart team will explain which device suits you and why. Your doctor may also review your other medicines if they are slowing your heart.

When is surgery considered?

Having a pacemaker is a procedure rather than open surgery. A leadless pacemaker is usually placed through a small puncture in a vein in the groin, using a thin flexible tube and X-ray guidance, often with mild sedation and local numbing. It usually takes under an hour, and many people go home the same day or the next day. A traditional pacemaker is placed through a small cut on the chest under local anaesthetic. Your team will explain the risks, which are uncommon but include bleeding, infection, and rarely damage to the heart or the vein, and will tell you what to expect afterwards.

Living with this condition

Most people recover quickly and get back to normal life. You may have some bruising or soreness where the catheter went in, which usually settles within days to a week or two. Your team will tell you when you can drive, shower, exercise and return to work — this varies from person to person. Once healed, most people do not notice the device at all; you cannot see or feel a leadless pacemaker from the outside. Regular checks, sometimes including remote monitoring from home, make sure the battery and settings are fine.

Lifestyle tips

• Stay physically active — walking, swimming, gardening and most sports are usually fine once you are healed; ask about contact sports
• Tell staff at gyms or spas that you have a pacemaker, and ask before using strong magnetic equipment
• Avoid pressing a mobile phone against your chest, and keep it on the side away from your device as advised
• Tell your team before travel, and carry your device card with you
• Limit alcohol and avoid smoking, as these put extra strain on the heart
• Ask your doctor before starting any new medicine, including over-the-counter ones and supplements

Diet and exercise

There is no special diet for having a pacemaker. A heart-friendly eating pattern — plenty of vegetables, fruit, wholegrains, beans, nuts and oily fish, with less salt, added sugar and processed food — supports your heart and blood vessels. Regular movement helps your heart work better and lifts your mood. Build up gently after the procedure, following your team's advice about lifting and strenuous activity, and aim for something you enjoy most days of the week.

Mental health and emotional wellbeing

It is very normal to feel anxious before or after getting a pacemaker. Some people worry about the device working, about feeling dependent on it, or about the procedure itself. Others feel a great sense of relief once their dizziness or fainting stops. Both reactions are understandable. Talking to your heart team, a GP, or a counsellor can help, and many people find it reassuring to speak with someone who already has a pacemaker. If low mood, worry or panic is affecting your daily life, please reach out for support — you do not have to cope alone.

Prevention

You cannot always prevent the heart rhythm problems that lead to a pacemaker, especially those caused by ageing or inherited conditions. But looking after your heart can lower the risk of some causes, such as damage from a heart attack or long-standing heart disease. If you already have a pacemaker, regular checks help catch problems early.

Vaccines

There is no vaccine that prevents the need for a pacemaker. Staying up to date with recommended vaccinations, including flu and pneumonia vaccines if offered, helps protect your heart and general health.

Screening programmes

There is no general screening programme for slow heart rhythms. Your GP may check your pulse at routine appointments, and an ECG is done if you have symptoms or a very slow pulse. If you have a family history of early pacemaker use or inherited heart rhythm conditions, tell your doctor, as family screening may be recommended.

Complications

If left untreated

• Fainting and falls, which can cause injuries such as a broken hip
• Ongoing tiredness and breathlessness that limit everyday life
• In some people, heart failure or worsening of existing heart problems
• Rarely, a very slow or paused heartbeat that becomes life-threatening
• Loss of confidence and independence, and low mood

Long-term outlook

The outlook is usually very good. Pacing is a well-established treatment, and most people find their dizziness, fainting and tiredness improve a lot, allowing them to get back to normal life. Leadless pacemakers are newer than traditional ones, but studies so far show good results, with generally low rates of serious complications. Your heart team will keep checking your device and your heart, and will plan a replacement or change of device when the battery comes near the end of its life. If you have any concerns at any point, your GP and heart team are there to help.

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