Leadless pacemakers: leading us into the future?: Figure 1

This editorial refers to ‘Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study’†, by P. Ritter et al., on page 2510. If at first the idea is not absurd, then there will be no hope for it. Since the first permanent pacemaker implant, almost 60 years ago, there has been continued progress and evolution of these devices. The technology has advanced on many fronts, with longer battery lives, smaller sized generators, with an intelligent ‘adaptive functionality’ closely mimicking the human physiology. However, contemporary implant technology has been disadvantaged by the need for a subcutaneous implantable device (with a risk for infection or erosion) and an attached pacing electrode system within the cardiac vasculature that itself is at risk for fracture and infection. The additional hazard of extracting malfunctioning or infected leads poses further challenges. Notably, almost 10% of the ∼700 000 pacemakers implanted annually worldwide are associated with lead-related problems.1,2 This, in turn, has created the need for a leadless pacemaker system.