| Abstract [eng] |
Artificial cardiac pacemakers have been the primary treatment for bradyarrhythmias for over half a century. However, transvenous pacemakers are associated with complications such as infections, lead dislocation, lead failure, and vascular occlusion, which management leads to significant healthcare costs. To mitigate these issues, leadless pacemakers have been developed. This thesis aims to review the latest scientific literature on leadless cardiac pacemakers, describe their mechanisms of action, indications, and contraindications, highlight key aspects of their implantation, and assess their effectiveness, safety, and associated risks. The literature review was conducted using “PubMed” (MEDLINE) and “The Cochrane Library” medical databases. The final analysis included 66 scientific publications and 6 manufacturers' user manuals. Leadless pacemakers integrate an impulse generator, a battery, and electrodes within a compact casing. These devices analyse cardiac electrical activity and initiate pacing when rhythm disturbances occur. They can function as single or dual-chamber devices, with pacing modes corresponding to transvenous pacemakers. To improve atrioventricular synchrony, models such as the “Micra AV”, which detects atrial activity, and the “Aveir DR”, a dual-chamber pacemaker capable of atrial pacing, have been developed. Dual-chamber leadless pacemakers use bidirectional, implant-to-implant communication via short electrical impulses transmitted through blood or myocardial tissue. Ventricular pacemakers are implanted in the right ventricle, whereas atrial pacemakers are placed in the right atrium. Leadless pacemakers are recommended for patients with limited upper extremity venous access, high infection risk, or those prone to complications related to transvenous pacemaker pocket formation. Single-chamber pacemakers are particularly suitable for patients with persistent or permanent atrial fibrillation accompanied by bradycardia. As technology advances, their indications continue to expand. Leadless pacemaker contraindications include mechanical tricuspid valves, inferior vena cava filters, allergies to device materials, or the presence of an implanted cardioverter-defibrillator or other electrically active cardiac device. Clinical studies demonstrate that leadless pacemakers are effective and safe, yet complications such as cardiac tissue perforation, pericardial effusion or tamponade, pacemaker dislocation, pacemaker syndrome, and pacing-induced cardiomyopathy can occur. The risk of complications is higher in patients with multiple comorbidities and is influenced by the surgeon’s expertise. Ongoing clinical trials are investigating a novel system that integrates a leadless pacemaker with an implantable cardioverter - defibrillator, which could play a crucial role in the comprehensive management of cardiac rhythm disorders. Leadless pacemakers are a new and promising technology that offers significant advantages over traditional transvenous pacemakers. However, long-term randomized controlled trials are needed to confirm their efficacy and safety. |
