Smaller, safer, smarter, leadless pacemakers offer new hope for the elderly

AS populations around the world continue to age, healthcare systems are under growing pressure to adapt to the complex needs of older adults.

Among the most pressing challenges is the rising prevalence of non-communicable diseases, particularly cardiovascular conditions, which remain a leading cause of death globally. This shift calls for innovative, age-appropriate medical solutions that can improve both longevity and quality of life.

Malaysia is no exception. The country is on the brink of becoming an ageing nation, with projections indicating that by 2030, 15.3 per cent of the population almost 5.8 million people will be aged 60 and above.

This demographic trend is intensifying the strain on healthcare services, especially in managing cardiovascular disease (CVD), which already ranks as the nation’s leading cause of death.

In 2016, coronary artery disease alone accounted for 13.2 per cent of CVD-related deaths, followed by stroke at 6.9 per cent. Alarmingly, the proportion of deaths due to CVD in public hospitals rose from 15 per cent in 2006 to 25.4 per cent in 2010, with the majority affecting those aged 60 and above.

These figures highlights the urgent need for safer, less invasive cardiac treatments tailored to an ageing population. For many elderly Malaysians with bradycardia or other heart rhythm disorders, conventional pacemakers can pose significant risks due to frailty, thin skin, and a higher likelihood of infection.

In this landscape, the leadless pacemaker, a tiny, self-contained device is emerging as a transformative breakthrough.
Dr Mohd Firdaus Hadi

Avisena Specialist Hospital, Consultant Physician and Interventional Cardiologist, Dr Mohd Firdaus Hadi said many older patients are unsuitable for conventional pacemakers due to limited venous access or a heightened risk of infection.

“They may have limited venous access or a higher risk of infection. Leadless technology helps us overcome many of these challenges safely and effectively,” he said.

Smaller than a vitamin capsule, the device is implanted directly into the right ventricle through a catheter via the femoral vein. This approach removes the need for a surgical pocket or leads, significantly reducing complications, scarring, and recovery time.

“It’s a revolutionary option for elderly patients. Not only is the procedure less invasive, but patients experience less discomfort and can resume normal activities much sooner compared to traditional devices,” Dr Firdaus added.

With a lifespan of up to 12 years, the device also reduces the need for repeat procedures, an important benefit for older adults.

Although especially beneficial for seniors, leadless pacemakers are not limited by age.

“Anyone with a heart condition that affects the electrical conduction system, such as complete heart block or other conduction abnormalities, may benefit from this technology.

“It’s a versatile solution that extends well beyond just age-related cardiac issues,” he said.

Dr Firdaus said that healthy ageing involves more than just living longer, it means living better. Innovations like leadless pacemakers enable elderly patients to live more confidently, knowing their hearts are supported by reliable and safe technology.

While conventional pacemakers still play a vital role in cardiac care, he said the availability of leadless options expands treatment possibilities, particularly for high-risk patients.

“As our population continues to age, having access to these innovations allows us to provide truly personalised care,” he added.

He emphasised that future-proofing the healthcare system requires investing in solutions that serve all patients, particularly the most vulnerable.

As the nation adapts to this demographic transformation, technologies like the leadless pacemaker are more than medical advancements, they are essential tools for improving the quality of life for an ageing society.