Pacemakers help to regulate dangerously abnormal heartbeats and arrhythmias by connecting to the heart’s electrical system via leads—thin, insulated wires that carry electrical pulses from the pacemaker’s pulse generator to electrodes inside the heart chamber. This has been the standard of pacemaker design for decades, but new innovations are reshaping pacemaker technology and the future of cardiac care.
One such innovation is the leadless pacemaker, which eliminates the need for leads connecting the pacemaker to the heart. Leading the way in this technology is Medtronic’s Micra leadless pacemaker, the world’s smallest pacemaker. Let us look at this remarkable device, its benefits to patients, and what to expect during and after a Micra leadless pacemaker implantation procedure.
Why the Micra Leadless Pacemaker
Traditional pacemakers consist of “the device”—an encased pulse generator, battery and electronic circuitry—that is surgically implanted under the skin outside the heart in the upper chest. This is connected to wire leads with electrodes at the end, which are guided through veins into the heart chamber. The electrodes sense the heart’s beat and deliver the electrical impulses needed to regulate it.
Unlike this traditional pacemaker, the Micra leadless pacemaker is a single, self-contained unit that is about the size of a vitamin capsule. It does not need leads to connect to the heart because the Micra itself is implanted directly into the heart’s right ventricle via a vein in the leg.
With a smaller device and minimally invasive implantation procedure, the Micra leaves no bump under the skin, no chest scar, no visible sign that you have a pacemaker! This also lowers the risk for complications that can come with traditional pacemakers—no surgical incision at risk of infection or restrictions on shoulder movements post-procedure. With no leads, there is no concern over lead malfunction or displacement, which can necessitate a lead extraction and replacement procedure.
Micra’s advanced technology makes living with a pacemaker easier and safer. Micra is “scanner” safe; it is designed, tested and approved for use with MRI scanners and security scanners. While traditional pacemakers have an average battery lifespan of eight to thirteen years, Micra has a battery that lasts upwards of 17 years!
Pre-Op: How Doctors Prepare You for the Micra Implantation Procedure
Is the Micra leadless pacemaker right for you? Only your doctor can determine that based on a patient evaluation with physical assessment, tests, and review of your medical history.
Micra is designed for treating symptomatic bradycardia, or slow heart rate, via one chamber of the heart, or single-chamber pacing. If your heart rhythm issue requires dual-chamber pacing, a biventricular pacemaker, or you also have or need a replacement heart valve, you will not be a candidate for the Micra or any form of leadless pacemaker.
Tests like an echocardiogram, electrocardiogram (EKG), stress test, and Holter monitoring can assess your general health and stamina, the heart’s current functionality and degree of rhythm problems. Your doctor will also consider any other medical conditions you have and previous procedures you have undergone, including previous pacemaker implantation. Mica is thought to be associated with a much lower risk of infections than transvenous pacemakers and is often the choice for high risk of infection patients.
If your doctor determines you are an ideal candidate for the Micra leadless pacemaker, it is on to the procedure!
Your pre-procedure consultation should cover:
- Procedure overview: The steps, risks, benefits, and any concerns or questions.
- Medication management: If you are taking blood thinners, the doctor will provide instructions on whether to stop taking them and for how long, as well as specific instructions on taking insulin if you are diabetic.
- Temporary pacing support: Depending on your condition, temporary pacing may be needed during the procedure. If so, your doctor will explain how this will work.
You should receive (and follow) standard pre-op instructions on bathing and cleansing, when to stop eating and drinking, and arranging transportation home from the hospital.
What to Expect During the Micra Leadless Pacemaker Implantation Procedure
The procedure to implant the Mica leadless pacemaker may take 30 – 60 minutes. As this procedure is minimally invasive, you will not go under general anesthesia. Instead, local anesthesia is used to numb the incision area, typically in the groin, accompanied by conscious sedation via IV to relax you during the procedure.
Once the anesthetic is administered, the Micra leadless pacemaker implantation procedure follows these steps:
- Your doctor will make a very small incision in your groin and will insert a straw-like catheter system through the incision into a vein, typically your femoral vein in the upper thigh area.
- Using X-ray, they will guide the catheter up through the vein to your heart, where the catheter system moves Micra into the right ventricle of the heart.
- Micra is placed against the heart wall and secured with flexible nickel titanium tines.
- Your doctor then tests Micra to ensure it is attached securely, programmed correctly, and working properly to regulate heart rhythm.
- The catheter is then removed and the incision site closed by applying pressure to the area and/or the insertion of a small surgical plug or special stitch.
After the procedure, you are moved to post-op recovery.
Post-Op: Immediate Post-Procedure Monitoring and What Comes Next
In recovery, you will need to lie flat and keep your leg straight for two to six hours to prevent bleeding from the incision site. You will have sterile dressing on the area to protect it from infection. If there is no bleeding issues, you should be able to walk and will probably be encouraged to do so by the observation team to check your mobility and discomfort level.
Before being discharged, the doctor will check your device performance and placement via X-ray. Depending on the time, how the procedure went, and your condition in recovery, you may be discharged that same day or spend the night in the hospital for further observation.
You will leave the hospital with the dressing still on the incision site, but you should be able to remove it by the next day. It is normal to see bruising in the groin and leg around the incision site but it should go down in a few days. You can shower once you remove the dressing, but you will want to wash the area gently with only soap and water. Avoid soaking the area, like in a tub bath or pool, for the first week post-procedure.
You should then be able to return to typical daily activities within one to two days. Avoid any strenuous activities, like exercising, and heavy lifting over 10 pounds for the first week post-procedure.
You should have a follow-up appointment with your doctor within two to four weeks after the implantation procedure to assess how you are healing, check Micra’s functionality, and clear any specific activities or your return to work, if you are not back at work already.
Overall, you should be back to your regular life within two weeks of your Micra leadless pacemaker implantation procedure with no additional restrictions. Compare that to life after standard pacemaker implantation procedure, with up to six weeks for the pacemaker incision site to fully heal and restrictions on arm and upper body movements for up to 12 weeks!
Join the Pacemaker Club
Want more on the latest pacemaker technology? Tap into additional resources and information through the Pacemaker Club, an online community where you can connect with fellow pacemaker recipients to ask questions, share experiences, and navigate your heart health journey with the support of our ForHearts Worldwide community.
Frequently Asked Questions About Micra
Is Micra leadless pacemaker implantation painful?
The Micra leadless pacemaker implantation should not be painful since you will receive local anesthesia and conscious sedation during the procedure. You may experience mild discomfort or pain at the insertion site afterwards, which can be managed with prescription pain medication.
Will I feel the Micra leadless pacemaker inside my body?
No, you should not feel the Micra leadless pacemaker once it is placed inside your body. This is due to its small size and placement directly into the heart’s right ventricle. This is unlike traditional pacemakers that are placed under the skin in the chest, which can cause a bump or scarring on the skin, and connected with leads, which can cause sensations or discomfort, especially if they become dislodged.
How soon after the implantation procedure can I return to normal activities?
You should be back to normal activities within two weeks of your Micra leadless pacemaker implantation procedure.
Are there risks associated with the Micra leadless pacemaker implantation?
Yes, there are risks associated with Micra leadless pacemaker implantation. These risks include:
- Cardiac perforation, where the device punctures the heart wall, potentially leading to fluid buildup around the heart and even death. The Micra has a higher risk of complications from cardiac perforation compared to traditional pacemakers.
- Pericardial effusion, the buildup of fluid around the heart, which can occur even with no cardiac perforation.
- Issues with the catheter system, which can lead to complications or injuries like perforation.
- Misplacement of the Micra device outside the right ventricular.
- Device dislodgement, migration and/or malfunction.
