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Implantable cardiac pacemakers save lives and improve quality of life. Each year about a million pacemakers are implanted worldwide, a quarter of them in the USA. Over the past 50 years several innovations have taken place in the miniaturisation of the pacemaker including circuitry, battery and lead systems. These advances have increased generator lifespan, improved programmability and simplified the `implant procedure.1
The non-surgical, leadless pacemaker is an innovative example of miniaturisation. Normal pacemaker batteries explode when exposed to very high temperatures and need to be explanted at the time of cremation. Miniaturisation and dramatic developments have taken place in battery development, but the explosive potential of the battery during cremation remains a conundrum and possibly increases with smaller more energy-dense batteries. The cremation hazard of this percutaneous pacemaker has been poorly studied, but with the rising number of cremations the world over, this hazard remains a serious concern.2 ,3
Several potential complications related to the transvenous lead (infection, venous obstruction, insulation break and conduction break), the subcutaneous pulse generator (pocket infection, haematoma) and the procedure itself (pneumothorax, tamponade) have led to innovations in the development of a self-contained leadless pacemaker. Although the concept is not new, it has taken over 40 years for two companies to develop this device. Medtronic Inc (Minneapolis, Minnesota, USA) developed their ‘Micra’ transcatheter pacing system about the size of a …
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