Dr Oliver Segal

The Micra™ leadless pacemaker is a miniaturised, single-chamber pacemaker system designed to pace within the right ventricle of the heart. It’s 93% smaller than traditional pacemakers and is delivered via a catheter from the leg.

The Micra™ device eliminates the need for a separate large battery, a device pocket and the insertion of a pacing lead, preventing many of the complications associated with traditional pacing implants.

If you decide to go ahead and have an implant, Dr Segal will insert a long plastic tube through the femoral vein at the top of your right leg and use it to implant the device directly inside the right ventricle of your heart.

The benefits of all implantable pacemakers are undisputed, delivering fast and lasting improvements in symptoms and, in some instances, an increased life expectancy. However, there’s a big difference between the various devices out there and the approaches that they take.

Traditional pacemakers consist of a battery (or generator) placed under the skin near the collarbone and connected to the heart by pacing leads. The large veins in the chest are then used as conduits for the leads to access the heart.

Even though there have been many ‘hidden’ technological advancements over time, particularly in device software features, until very recently this basic system design hadn’t changed since the inception of implantable pacemakers in the late 1950s.

However, it’s been clear for some time that:

• Placing the battery near the skin can significantly increase the chances of an infection developing around the pacemaker pocket, particularly after battery or lead replacement procedures.
• Leads are the ‘weak link’ as long-term exposure to constant movement at the shoulder and within the heart can sometimes result in their fracture or in insulation failure. 
• Traditional pacing leads have a life expectancy of approximately 10 years and then require replacement and, potentially, extraction. That’s a significant risk if they’ve been in the body a long time.

The Medtronic Micra™ leadless pacemaker potentially offers a near-perfect solution to all these problems.

There are multiple potential benefits of having a Micra™ implanted versus a traditional pacemaker device:

• No scar over the chest wall
• No pocket for the pacemaker battery, meaning a lower infection risk and no risk of bleeding or a clot in the pocket requiring a repeat operation
• The pacemaker battery isn’t visible and can’t cause discomfort under the skin
• No risk of collapsed lung (pneumothorax)
• No risk of bleeding in the lung (haemothorax)
• No risk of blood vessel clot or occlusion due to the long-term presence of a pacemaker lead
• No risk of pacemaker lead failure
• No risk of splinting open a tricuspid valve flap causing it to leak
• No need for the risky excision of the battery from the pocket or for lead extraction
• Longer battery life than traditional pacemakers, up to 15 years
• 50% reduction in overall complication rates versus traditional pacemakers
• Reduction in re-operation rates versus traditional pacemakers
• The implant is still possible even if your neck and arm veins are occluded from previous treatments such as traditional pacemaker implants, long-term catheter insertion or radiotherapy

Keen to find out more? Dr Segal can help.