Cardiologists at UVA Health are using a new type of leadless pacemaker in an ongoing clinical trial that could help patients with slow heart rhythms while preserving the natural timing between the heart’s upper and lower chambers.
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Pacemakers are used to treat some forms of bradycardia, a condition in which the heart beats too slowly.
“Slow heart rate is typically less than 60 beats per minute,” although trained athletes can have resting heart rates as low as 30 beats per minute, said Dr. Oliver Monfredi, a UVA Health cardiologist who specializes in treating patients with abnormal heart rhythms.
Most people experience what seems like a skipped heartbeat, or an occasional flutter, which is nothing to worry about, Monfredi said.
However, people who experience prolonged palpitations, or palpitations accompanied by lightheadedness, fainting, chest pain or shortness of breath, should speak with a healthcare provider, Monfredi said, because those symptoms can signal an underlying heart-rhythm problem.
Normally, the heart’s natural pacemaker, the sinus node in the right atrium, generates electrical impulses that travel through the heart and trigger each heartbeat, but with bradycardia the electrical signal is delayed or blocked on its way to the ventricles.
As part of an ongoing clinical trial, the Biotronik LivIQ is the latest advance in leadless pacing technology, building on FDA-approved devices such as the Medtronic Micra, one of the first leaderless pacemakers implanted directly into the heart’s right ventricle. With no leads, a leadless pacemaker, which is approximately the size of a small bullet, is implanted through a minimally-invasive catheter inserted into the femoral vein and guided into the right ventricle.
Manfredi said the LivIQ addresses a key challenge in leadless pacemakers.
“The main way in which it differs is how it maintains synchronized beating between the top and bottom chambers of the heart,” Monfredi said.
The challenge has been maintaining communication between the chambers without a lead connecting them.
“The beauty of this particular new device is that it has the ability, even though it’s in the bottom chamber of the heart, to see the electrical signal from the top chamber of the heart, what we call a far-field signal,” Monfredi said.
By sensing that signal, and listening for the faint, electrical current generated by the atrium when it contracts, the device can time its pacing so the top and bottom chambers continue to beat in coordination.
“That’s really important because if we lose that synchronization between the top and bottom chambers of the heart, then the heart doesn’t function as efficiently and people can feel worse,” he said.
Other pacemakers on the market, including the Aveir, made by Abbott, include one unit in the top right chamber of the heart, and one in the bottom right. In a 2023 interview with WTOP, electrophysiologist Cyrus Hadadi said the two components in the Abbott unit “communicate with one another through your bloodstream itself,” through a technology called implant to implant, or “i2i.” The proprietary technology uses far less battery current than inductive, radio frequency or Bluetooth communication, according to the company.
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