Leadless Pacemaker Experience at Rutgers New Jersey medical School and Arrhythmia Institute at University Hospital

Expert Author
Emad F. Aziz Cardiac Electrophysiologist Newark, New Jersey

Dr. Emad F. Aziz is a top Cardiac Electrophysiologist in New Jersey. With a passion for the field and an unwavering commitment to their specialty, Dr. Emad F. Aziz is an expert in changing the lives of their patients for the better. Through their designated cause and expertise in the field, Dr. Emad F. Aziz is a prime... more

Dr. Aziz, as Chief of Cardiac Electrophysiology at Rutgers New Jersey Medical School, has been at the forefront of adopting and embracing leadless pacemaker technology for our patient population.

Since the introduction of the Micra VVI (single pacemaker in the ventricle) back in 2018, Dr. Aziz has utilized it in numerous indicated patients. His early work, which has been published, demonstrates the efficacy of Micra VR in patients with spinal cord injuries, octogenarians, and even during the COVID-19 pandemic.

With the subsequent introduction of Micra AV, Dr. Aziz has expanded the scope of patients who can benefit from leadless pacemakers, particularly focusing on young patients with syncope and older patients with complete heart block.

Recently, the electrophysiology team at University Hospital, led by Dr. Aziz, became one of the few institutions in the country to offer the newly approved dual-chamber Avier leadless pacemaker.

This advancement further broadens the options available for patients in need of pacemaker therapy, highlighting our commitment to advancing cardiac electrophysiology through innovative technologies.

Approximately 350,000 pacemakers are implanted annually in the US and with an ageing population and increasing pacing indications, their utilization is expected to increase.
Traditional pacemaker (TVPMs) has been around since the 1950s, and despite several advancements; the potential for complications and technical failure with TVPMs continue to be problematic.
Short term complications are seen in up to 12% of these patients and long-term complications in 15-16%, representing a significant health and economic burden to both the patient and healthcare systems, with the mean cost of pacemaker complications per patient around $6,674 ± 3,867 at 3 years in a study.

Previously, both the leading LPMs have been shown to have excellent efficacy in addition to the advantage of a better safety profile than the TVPMs. In the Micra Post Approval Registry, the risk of major complications was 63% lower than that for patients with TVPMs through 12 months post-implantation (hazard ratio 0.37; 95% CI 0.27-0.52; p <0.001). In January 2020, Micra AV–LPM was approved for use in patients with AV block as a high efficacy was achieved with AV synchrony in these patients in the MARVEL-2 study.

What make this technology very appealing is small size, no need for surgical cuts, versatility of programing, MRI compatibility, capability in performing various diagnostics such as (battery status, threshold, impedance, % paced) and projected battery life ~ 12 - 17 years.

These devices are implanted via a femoral access (27F) outer diameter and the actual pacemaker is (23F).

When to consider Leadless Pacemaker Implantation” Current Indications”

The Micra transcatheter pacing system may be considered medically necessary when BOTH of the following conditions are met:

The patient has ONE of the following conditions: 

Symptomatic paroxysmal AV block, permanent high-grade AV block, symptomatic bradycardia-tachycardia syndrome, sinus node dysfunction (sinus bradycardia or sinus pauses). The patient has a significant contraindication precluding placement of conventional pacemaker such as CIED (infection), limited access because of (AV fistula), presence of bioprosthetic valve.

 First dual chamber leadless pacemaker system:

The AVEIR™ DR Leadless Pacemaker (LP) System is a first-of-its kind, dual chamber leadless pacing system featuring:

Two distinct devices Each specifically designed for the right atrium or right ventricle.

In both chambers Sensing and pacing in both the right atrial and right ventricular chambers.

For atrioventricular (av) synchrony Made possible through proprietary implant-to-implant (i2i™) communication. >95% Mean AV synchrony observed for multiple postures and gaits (including sitting, supine, left lateral recumbent, right lateral recumbent, standing, normal walking and fast walking)

With AAIR, VVIR & DDDR options Match your patients’ pacing needs and upgrade over time as those needs change.

Electrical mapping prior to fixation Reduces the number of repositioning attempts to find your optimal implant site.

 

For further information contact the Arrhythmia Institute at University Hospital Dr. Emad Aziz (Emad.Aziz@Rutgers.Edu)

Arrhythmia Service APN: Hyoeun Kim (kimhy7@uhnj.org)

Arrhythmia Service Navigator:

Yajaira Maldonado ( maldony1@uhnj.org)

For Appointments Call: (973) 972-9222 or (973) 972-5742