Health Essentials from Cleveland Clinic

If your heartbeat is irregular, too slow or too fast, there is reason for concern. But there’s often a fix for this problem. For many patients, the answer is a pacemaker — an implantable electrical device that can help regulate your heart. And that technology has improved in important ways in recent years.

Traditional pacemakers — ones that require surgery to implant the device and wires to connect it to the heart — can have unwanted complications, says cardiologist Daniel Cantillon, MD. Leadless pacemakers are an effective way to sidestep those issues.

“Having the option of a leadless pacemaker is important because surgical incisions are the most common complications for traditional pacemakers,” he says. “And, in an analysis of patient data, we’ve found that one in six pacemakers are, in fact, affected by complications.”

Here’s what you need to know about leadless pacemakers and whether one might be right for you.

Important differences

Leadless pacemakers are self-contained. Doctors implant them into the heart’s right ventricle via a catheter threaded through the leg, which is then removed once the device is deployed internally.

They require no wires and no surgical pocket in the heart. They help keep a patient’s heart from beating too slowly, a condition called bradycardia.

Symptoms of bradycardia may include:

• Dizziness
• Lightheadedness
• Fatigue
• Difficulty breathing with exertion

Are you a good candidate?

The devices work well for roughly 10 percent of patients with bradycardia who require a pacemaker,  Dr. Cantillon says.

Within this group, those who will most benefit from leadless pacemakers experience three types of problems, he says.

1. Atrial fibrillation — Patients with atrial fibrillation can have alternating periods of very fast and slow heartbeats (the so-called “tachy-brady syndrome”). A pacemaker can prevent your heart from beating too slowly. Doctors sometimes use the device in conjunction with drugs that keep the heart from beating too quickly, Dr. Cantillon says.
2. Intermittent heart block — For those whose hearts pause due to intermittently failing electrical impulses (heart block), the device can fill in the gaps with pacing. Such patients require pacing infrequently, but the need often is critical, Dr. Cantillon says. “Without a pacemaker, the heart can pause during these ‘power outages,’ ” he says. “That can cause poor circulation, loss of consciousness, falls and injury as a result.”
3. Traditional pacemaker problems — Scar tissue can develop around pacemaker wires, causing venous occlusive disease. This causes blood vessel blockages, intense headaches, and other problems, Dr. Cantillon says. Traditional pacemakers also require incisional access, which is prone to infection when the batteries need to be replaced. To address these problems, a doctor will remove the traditional pacemaker, treat the patient and then implant a new leadless device. Infections are rare with leadless pacemakers, he says, and venous occlusion is unheard of with them.

Why a leadless pacemaker may not work for you

Among eligible patients, there are still some who shouldn’t use them, Dr. Cantillon says. You fall into this category if:

• You have a filter device in the inferior vena cava, the large blood vessel responsible for returning blood from your lower body to your heart. This filter helps prevent blood clots from reaching your heart.
• You have a mechanical valve on the right side of your heart.
• You have blood vessel disease in your legs that prevents a doctor from running wires and catheters to your heart.
• You have blood clots in both legs.

If a leadless pacemaker won’t work for you at this time, it can still become an option in the future.

Researchers continue to focus on developing leadless pacemakers that will work for the remaining 90 percent of patients with bradycardia who require a pacemaker, Dr. Cantillon says.