Next Phase for EP: Leadless Pacing
The electrophysiology boon is sometimes overshadowed by the problems associated with device leads. They can malfunction from faulty manufacturing or become infected, and they sometimes have to be removed in these circumstances. In an ideal world, there would be leadless pacing. And, that ideal world might be closer than ever.

Researchers from Hong Kong determined that leadless pacing with ultrasound-mediated stimulation energy is feasible in patients with advanced heart failure. While the study was small, only 10 patients, investigators achieved successful leadless pacing in all of the participants. Such technology could avoid complications associated with leads, the researchers wrote, and called for more research in this area, now that they’ve shown its feasibility.

In the meantime, electrophysiologists have to deal with the many patients they see with lead dysfunction or infection. Device expert Dr. Bruce Wilkoff explained to Cardiovascular Business News that lead extraction is safe, but the procedure needs to be done by very experienced EPs.

In fact, Dr. Laurence Epstein at Brigham and Women’s Hospital says that lead extraction is the one procedure with the largest learning curve.

However, the good news is that in the hands of experienced operators, the procedure can become rather routine. The field’s understanding of lead extraction has deepened and the tools have improved. The only impediment left is ensuring that enough EPs have the proper training for this growing field of electrophysiology.

To stay current with this fast-changing area of EP, the Heart Rhythm Society published the first comprehensive guidance document on lead performance in pacemakers and implantable cardioverter defibrillators (ICDs). The document provides a range of recommendations including communication of lead performance, threshold for action and communication after abnormal lead performance is identified and clinical recommendations for physicians.

Another area where EP is making strides involves wireless transmission of device data from the patient’s home, such as St. Jude's recently CE Marked products that feature radiofrequency telemetry. One of the advantages of these products is that the data can be integrated directly into the patient’s EMR. This type of technology is increasingly important as the number of patients receiving ICDs increases and as more and more of these patients and their caregivers opt for wireless transmission as a means to improve patient care and facility workflow.

In addition, the Heart Rhythm Society's new guidelines on lead performance suggest that remote monitoring be used as a post-market surveillance tool.

If you or your group is interested in finding out more about the electrophysiology, head over to our Healthcare TechGuide and check out the variety of companies that offer products and services.

Lastly, if you have a comment or report to share about the growing field of EP, please contact me at the address below. I look forward to hearing from you.

Chris Kaiser, Editor