[Leadless atrial pacemaker : New perspectives in cardiac pacemaker treatment]

Previous leadless pacemaker systems were confined to the right ventricle, thus limiting the clinical applications. With the introduction of the first leadless atrial cardiac pacemaker, new perspectives in antibradycardia treatment were introduced. This device enables leadless atrial stimulation and electrical atrial sensing with the potential to reduce complications of cardiac pacemaker treatment. The atrial leadless atrial pacemaker is implanted transvenously with a delivery catheter via the femoral vein into the base of the right atrial appendage. In combination with a ventricular leadless pacemaker, a complete dual chamber pacemaker system can be created through galvanically coupled intracorporeal communication. This can be created as an upgrade from an already implanted ventricular or atrial leadless cardiac pacemaker or the system can be implanted directly (de novo). The possibility of an upgrade enables a flexible treatment adapted to the individual progression of the underlying disease. Current limitations for wider clinical use include economic considerations, limited battery capacity and insufficient data concerning retrievability after the battery is exhausted.