ECGs and Pacemakers

Leadless pacemakers will most likely be the future of cardiac pacing. Leadless pacing employs a singlechamber system to pace only the right ventricle and is fully self-contained, which eliminates the need for leads. These systems, implanted by using a transcatheter sheath, are indicated for patients who need right ventricular pacing only. These devices enable patients to avoid lead-related complications, from lead fracture to extraction challenges, as well as pocket-related complications such as infection and disfigurement. Leadless pacemakers also are compatible with magnetic resonance imaging and do not require surgical placement, so patients avoid postoperative mobility restrictions. Because this technology will be increasingly used for cardiac internal electronic devices, commonly seen in critical care nursing, nurses must be knowledgeable about the indications for use of a wireless pacemaker, the implantation procedure, postprocedural care, device interrogation, and follow-up. This article discusses leadless pacemakers, clinical indications for their use, key similarities and differences between the current devices being used, key points for nursing care of patients with a leadless device, and the future of this technology. (Critical Care Nurse. 2017; 37[2]:58-65) Mary Leier, MScN, FNP-BC Advancements in Pacemaker Technology: The Leadless Device