Device Evaluation

*Author for correspondence: Tel.: +44 (2) 380 777 222; Ext.: 3928;

https://orcid.org/0000-0003-0805-5017

Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK

Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK

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Paul R Roberts

Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK

Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK

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Published Online:7 Dec 2023https://doi.org/10.2217/fca-2023-0093

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Abstract

Leadless permanent pacemakers represent an important innovation in cardiac device developments. Although transvenous permanent pacemakers have become indispensable in managing bradyarrhythmia and saving numerous lives, the use of transvenous systems comes with notable risks tied to intravascular leads and subcutaneous pockets. This drawback has spurred the creation of leadless cardiac pacemakers. Within this analysis, we compile existing clinical literature and proceed to evaluate the efficacy and safety of the Micra Transcatheter Pacing System. We also delve into the protocols for addressing a malfunctioning or end-of-life Micra as well as device extraction. Lastly, we explore prospects in this domain, such as the emergence of entirely leadless cardiac resynchronization therapy-defibrillator devices.

Plain language summary

What is Micra?

Micra is a type of leadless pacemaker. Leadless pacemakers are a relatively recent breakthrough in medical science. Regular pacemakers have wires that run into the heart and a battery tucked under the skin. They are crucial for treating slow heartbeats. However, they carry risks tied to the wire or batteries. The Micra is placed in the heart using a tiny cut near the groin. There is no wire left behind in the body. Using Micra can avoid the potential complications linked to regular pacemakers.

Is Micra safe & effective?

Scientists have found that Micra is effective in patients with appropriate heart rhythm issues. There seem to be fewer complications compared to the regular pacemakers.

What does the future hold for Micra?

There are concerns about what to do when the battery runs out. The technology and batteries in Micra are getting better. It is expected Micra will be used even more in the future.

Tweetable abstract

Leadless pacemaker: the future of bradyarrhythmia therapy? Promising clinical efficacy and safety parameters. Micra^TM AV system providing AV synchronous pacing. Leadless atrial pacemakers underway. Future applications in entirely leadless CRT systems, modular configurations and the paediatric demographic are notably intriguing.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 19, No. 15

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Received 3 July 2023

Accepted 13 October 2023

Published online 7 December 2023

Published in print December 2023

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Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

L-T Toon received an unrestricted research grant from Boston Scientific. PR Roberts receives consultancy fees from Boston Scientific and Medtronic. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

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The Micra Transcatheter Pacing System: past, present and the future