Leadless Cardiac Pacemaker as a Novel Intervention Modality for Atrioventricular Conduction Disturbance in Hypertrophic Cardiomyopathy

Henry Sutanto


Atrioventricular conduction disturbance is a common complication of cardiovascular diseases, such as hypertrophic cardiomyopathy. Moreover, the most common form of atrioventricular conduction disturbance is atrioventricular block. Until recently, cardiac pacing was considered to be the most reliable long-time management of atrioventricular block. However, cardiac pacemakers have several limitations and complications. When the first generation of leadless pacemakers was invented in the 1980s, it was multi-component. Nowadays, self-contained or single component leadless pacemakers have been developed and have become popular amongst cardiac electrophysiologists. In particular, in 2013, St. Jude Medical developed a novel design for a cardiac pacemaker called the NanostimTM Leadless Pacemaker. In 2015, Medtronic released a smaller leadless pacemaker called the MicraTM Transcatheter Pacing System.1,2 Although NanostimTM and MicraTM represent state of the art technology; a few studies have documented some of their limitations.3-6 More research is needed to confirm and solve these problems


St. Jude Medical. St. Jude Medical announces acquisition and CE mark approval of world’s first leadless pacemaker. News Release. 2013;1: 1-3.

Medtronic. Medtronic announces preliminary outcomes for world's smallest cardiac pacemaker. Press Release. 2014. [Accessed 2016 Mar 15]. Available from: http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irolnewsArticle&id=1941080.

Miller MA, et al. Leadless cardiac pacemakers: back to the future. JACC. 2015; 66(10): 1179-1189.

Reddy VY, et al. Permanent leadless cardiac pacing: Result of the LEADLESS trial. Circulation. 2014;129: 1466-1471

Knops RE, et al. Chronic performance of a leadless cardiac pacemaker: 1-year follow up of the LEADLESS trial. JACC. 2015;65(15): 1497-1504.

Ndegwa S. Leadless pacemakers for the treatment of cardiac arrhythmias (Issues in emerging health technologies), Canadian Agency for Drugs and Technologies in Health. 2015;134: 1-9.

Andreasen C, et al. New population-based exome data are questioning the pathogenicity of previously cardiomyopathy-associated genetic variants. European Journal of Human Genetics. 2013;21: 918-928.

Katayama T, Tsuruya Y, Ishikawa S. Complete atrioventricular block and infective endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Intern Med. 2012;51: 749-753.

Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013;381: 242-255.

Zimmerman F. ACCP critical care medicine board review 21st Ed. 2015. DOI: 10.1378/critcare.21.11

Vardas PE, et al. Guidelines for cardiac pacing and cardiac resynchronisation therapy. European Heart Journal. 2007;28: 2256-2295.

Freidberg CK, Donoso E, Stein WG. Nonsurgical acquired heart block. Ann N Y Acad Sci 1964;111: 835.

Gadboys HL, Wisoff BG, Litwak RS. Surgical treatment of complete heart block: an analysis of 36 cases. JAMA 1964;189: 97.

Johansson BW. Complete heart block: a clinical, hemodynamic and pharmacological study in patients with and without an artificial pacemaker. Acta Med Scand 1966; 180(Suppl. 451):1.

Hindman MC, Wagner GS, JaRo M et al. The clinical significance of bundle branch block complicating acute myocardial infarction: indications for temporary and permanent pacemaker insertion. Circulation.1978;58: 689–699.

Donmoyer TL, DeSanctis RW, Austen WG. Experience with implantable pacemakers using myocardial electrodes in the management of heart block. Ann Thorac Surg 1967;3: 218.

Edhag O, Swahn A. Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers: a long-term follow up study of 101 patients. Acta Med Scand 1976;200: 457–463.

Barold SS, et al. First-degree atrioventricular block. J Interv Card Electrophysiol. 2006;17: 139-152.

Neuzil P, Reddy VY. Leadless cardiac pacemakers: pacing paradigm change. Curr Cardiol Rep. 2015;17(68): 1-8.

Sperzel J, et al. State of the art of leadless pacing. Europace. 2015. doi:10.1093/europace/euv096

Lan T, et al. Safety and feasibility of leadless pacemaker compared with traditional transvenous single-lead pacemaker: an animal study. 2015. DOI: 10.1111/pace.12270.

Steinberg J, et al. The ‘Leadless’ pacemaker: a novel alternative to a traditional transvenous pacemaker. Arrhythmia News. 2015;3(4): 1-2.

Huynh K. Newly designed leadless pacemaker. Nature Reviews Cardiology. 2015;12: 1.

Koruth JS, et al. Feasibility and efficacy of percutaneously delivered leadless cardiac pacing in an in vivo ovine model. J Cardiovasc Electrophysiol. 2015;26: 322-328.

Reddy VY, et al. Percutaneous implantation of an entirely intracardiac leadless pacemaker. N Engl J Med. 2015;373: 1125-1135.

ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US); 2000 -. Identifier NCT02004873, The micra transcatheter pacing study; 2013 May [Accessed 2016 Feb 2]. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02004873

Phillips R. Leadless pacemaker demonstrates safety, efficacy and retrievability. Nature Reviews Cardiology. 2015;12: 1.

BIBA Medical. Leadless pacing: an exciting new technology [Internet]. In: Cardiac Rhythm News. London; 2014 Jun 23 [Accessed 2016 Feb 5]. Available from: http://www.cxvascular.com/crn- highlights/cardiac-rhythm-news---highlights/leadless- pacing-an-exciting-new-technology.

O'Riordan M. First-in-human data shows medtronic's leadless pacemaker safe out to 90 days [Internet]. New York: Medscape; 2014 Jun 19. [Accessed 2016 Feb 5]. Available from: http://www.medscape.com/viewarticle/827034

Tjong FVY, et al. Postmortem histopathological examination of a leadless pacemaker shows partial encapsulation after 19 months. Circ Arrhythm Electrophysiol. 2015;8: 1293-1295.

Krypta A, Blessberger H, Lichtenauer M. Complete encapsulation of a leadless cardiac pacemaker. Clin. Res Cardiol 2016;105(94): 1.

Mountfort K, et al. The promise of leadless pacing. Radcliffe Cardiology Arrhythmia & Electrophysiology Review. 2014.-: 51-55.

Bonner M, et al. Early performance and safety of the micra transcatheter pacemaker in pigs. PACE 2015; 38: 1248–1259.

Meyers JD, Jay PY, Rentschler S. Reprogramming the conduction system: onward toward a biological pacemaker. Trends in Cardiovascular Medicine. 2016;26: 14-20.

Boink GJJ, et al. The past, present, and future of pacemaker therapies. Trend in Cardiovascular Medicine. 2015;25: 661-673.

Saito Y, et al. Enhancement of spontaneous activity by HCN4 overexpression in mouse embryonic stem cell-derived cardiomyocytes - a possible biological pacemaker. PloS One. 2015;10(9): 1-16.

DOI: https://doi.org/10.17987/jatamis.v2i0.358


  • There are currently no refbacks.

Copyright (c) 2017 Henry Sutanto

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN: 2518-6140 (on-line version)