The past few years have seen rapid and transformative developments in the field of clinical cardiac electrophysiology. Disruptive technologies include the development and launch of new cardiac ablation technologies for invasive treatment of atrial and ventricular tachyarrhythmias, as well as novel cardiac implantable electronic devices (CIEDs) for managing patients with cardiac conditions such as bradyarrhythmias, syncope, heart failure and increased risk of sudden cardiac death.

In February 2020, members of the UW Health clinical cardiac electrophysiology team successfully performed the first-in-state leadless pacemaker implant utilizing a device capable to provide A-V synchronization (the Micra^TM AV) at University Hospital.

“These modern technologies are helping us deliver care…with a lower risk of short- and long-term complications,” explains Miguel Leal, MD, assistant professor (CHS), Cardiovascular Medicine, and director of the UW Health electrophysiology and arrhythmia service. “Remote monitoring technology has also allowed for these patients to be safely followed in a longitudinal fashion from their own homes, without the need for in-person assessments more than once or twice per year,” he continues, noting that this is a change from previous technologies that required frequent face-to-face check-ins.

Leadless pacemaker technology is still at an emerging stage, and Dr. Leal explained that devices such as these are expected to be used preferentially for patients with conditions that increase the peri- and/or post-operative risks associated with a traditional transvenous pacemaker implant.

Unlike traditional endovascular (transvenous) devices, leadless pacemakers offer no risk of a pocket site hematoma or lead fracture/failure, as those components simply do not exist in this type of system, making these novel devices safe and efficacious alternatives for treatment of patients with symptomatic bradycardia.

The UW Health electrophysiology and arrhythmia service has an established nationwide and international reputation for management of patients with cardiac implantable electronic devices and leads. This is another example in a long tradition of implementation of novel technologies, including the subcutaneous defibrillator (first implanted in Dane County in 2014), the miniaturized implantable loop recorder (first implanted in Wisconsin in 2014) and the original leadless pacemaker (first implanted in  Wisconsin in 2016).

Resources

• UW Health: Heart Rhythm Disorders. Accessed April 17, 2020.

Banner image: File photo of Dr. Miguel Leal at University Hospital. Credit: Clint Thayer/Department of Medicine