Pacemaker Placement - Times are Changing

Written by Matthew Kapalis, DO, FHRS

How do we place a pacemaker? This is no longer as straight forward as it used to be. Now a days as electrophysiologists, we have multiple lead and pacemaker designs which allow for new ways to place a pacemaker.

Traditionally a pacemaker lead was inserted from the vein that passes under the collar bone, advanced to the right ventricle and ultimately placed in the right ventricular apex. With lead placement in this area, it would then stimulate the ventricular muscle to regulate one's pulse. However, over the last 25 years we have found a large number of people developed inefficient heart contractions with these paced beats. The concern with these inefficient heart contractions is that they can cause some patients to develop cardiomyopathy. To correct this, there were pacemakers designed for the placement of multiple leads in the ventricular muscle. However this raised the question, are there locations within the ventricle muscle that would be less prone to pacemaker induced cardiomyopathy?

The result of this question being posed was the development of pacing the heart’s conduction system. By using the heart’s natural electric communication network, we could regulate the heart rate and efficiently cause the heart to contract. Utilizing this method would mean the ability to prevent or correct cardiomyopathy due to pacing or inefficient electrical conduction through the ventricle.

In October 2022, the FDA approved a lead designed for conduction system placing. With this, the implantation technique rapidly gained popularity. Specifically speaking, with conduction pacing the lead is now placed in the left bundle. The left bundle branch area is the larger of the conducting fibers in the main pumping chamber of the heart and allows for a very stable lead position with durable long-term performance. An additional added benefit with this placement is the left bundle branch’s location within the heart, is out of the way if other future cardiac procedures like ablations, valve interventions, etc. are needed. Bryan Heart Electrophysiologists and the electrophysiology lab team at Bryan Medical Center have been implanting conduction system pacing leads since May 2023.

Our goal with use of this technology is to provide our patients better long term outcomes with less complications. Not every patient requires this type of pacemaker and individualized care discussions are extremely important, but this advancement in technology can be a key step to improving quality and quantity of life. We are proud to deliver this type of innovative care to our Bryan Heart patients.

For additional questions specific to pacemaker or device implants, please reach out to our Bryan Heart Electrophysiology Department at 402-483-3333.

Source:

1. J Am Coll Cardiol EP. 2023 Nov, 9 (11) 2358–2387