A major complication with traditional pacemakers and defibrillators is the risk of infection, which may require the removal of the leads—insulated wires that convey electrical impulses to the heart. Additionally, these leads are susceptible to breaking, requiring their removal. Extracting leads is a complex procedure that requires specialized equipment and poses increasing risks the longer the leads are embedded in the body and the more they become integrated with heart tissue and blood vessels. Now, a new system described in an article published in the New England Journal of Medicine, marks a significant advancement in cardiac care and promises safer and more effective treatment for patients.

This groundbreaking system, developed through an international study involving dozens of researchers worldwide, including from the University of Tennessee Health Science Center (Memphis, TN, USA), combines an atrial leadless pacemaker with a novel subcutaneous defibrillator. The new devices aim to eliminate the hazardous complications associated with conventional devices by doing away with the need for lead extraction. The subcutaneous defibrillator is implanted on the left side of the body near the ribcage, with the wire routed subcutaneously and positioned above the sternum, ensuring no contact with the blood pool. Conversely, the leadless pacemaker, roughly the size of an AA battery, is implanted in the leg, led through the femoral vein and attached to the inside of the heart. These two devices communicate wirelessly to correct dangerous cardiac arrhythmias without the need for direct electrical shocks to the heart.

“When the leadless pacemaker sees a dangerous heart rhythm, it can appropriately respond to that event, it can perform antitachycardia pacing, and it can respond back to the defibrillator that it was doing that, so the defibrillator doesn’t shock the patient,” said Harish Manyam, MD, interim chair of the Department of Medicine at the University of Tennessee Health Science Center’s College of Medicine, who was part of the international study that involved dozens of researchers worldwide. “If that doesn’t work, the pacemaker will let the defibrillator know, and the defibrillator itself will shock the patient.” 

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