Q: Please describe your experience with leadless pacemakers.
A: I started implanting leadless pacemakers during my fellowship at Geisinger and MedStar, where I had incredible training opportunities. Since then, I have implanted close to 300 leadless pacemakers and counting. What drew me to leadless technology was its ability to solve so many of the challenges we see with traditional pacemakers, especially lead-related issues like fractures. It is a game-changer for device management because when there is no lead, there is no lead problem!
Q: What was your experience during the initial learning phase of implanting AVEIR LPs?
A: I will never forget my first case. It was exciting but also a reminder that every new procedure comes with its own challenges. With AVEIR LPs, I had to respect the differences and adapt to a new way of thinking about pacing. The biggest hurdle early on was learning how to work with the catheter and understanding how patient anatomy, especially in more complex cases with tortuous vasculature or a sigmoid septum, could impact implantation. The AVEIR Catheter is an incredibly powerful tool, but it takes time and experience to use it to its full potential.
However, after each procedure, I could feel my technique improving. I became more comfortable with the subtle movements needed for precise placement and started recognizing patterns in anatomy that helped guide my approach. By the time I had done around 10 to 20 cases, I felt a real shift in confidence. Things that initially felt challenging, like fine-tuning positioning and maneuvering the catheter, became second nature. It is a rewarding learning process, and with every implant, you refine your skills even further.
Q: What specific skills or training helped you overcome the learning curve?
A: As a cardiac electrophysiologist, a lot of our training involves manipulating catheters, especially through the femoral approach. Procedures like catheter ablation for atrial fibrillation or left atrial appendage occlusion require finesse with larger catheters and accessing veins in a similar way. So, in many ways, leadless pacemakers felt like a natural fit. It wasn’t necessarily about specific training advantages, though – it was more about mindset. I quickly realized that leadless pacemakers are evolving faster than traditional devices and, in many ways, are more advanced. Once I saw that, I committed to mastering this new technology and staying ahead of the curve.
Q: Can you share any key lessons you’ve learned after completing so many AVEIR LP implants?
One of the key lessons is that the fundamentals really are fundamental. From the start, I have relied on ultrasound-guided femoral access, using the introducer as a support, and focusing on safely targeting the ventricular septum. These basics haven’t changed much, though over time, I have definitely become faster and more efficient. The other important lesson I have learned, though, is that it is not just about mastering the technical skills. The real challenge comes in shifting your mindset. Leadless pacemakers require us to rethink how we approach pacing and device management. It is about embracing this new technology early on and, just as importantly, sharing that enthusiasm with everyone around you – partners, patients, allied health professionals, and referring physicians. The more we all focus on leadless pacing, the faster it becomes the norm.
Q: What kind of support, either from peers or manufacturers, is available for physicians new to leadless pacemaker implants?
A: Abbott has really set the bar high when it comes to training. Their fellows’ educational pathways and formal training programs are extremely thorough, which makes a huge difference for those starting out. On top of that, there is a strong network of physicians, like me, who are always available to offer support whether it is online, in person, or through a quick text or call. I am always happy to chat and offer advice, especially when it comes to challenging cases. I think most of us who are passionate about leadless pacemakers feel the same way and are eager to help others in the field.
Q: What advice would you give to physicians starting with AVEIR LPs?
A: Do not be intimidated by the technology! It is completely normal to feel unsure at first. You have to walk before you run, so focus on getting through your first case, then your second, and so on. It won’t be long before you are on your hundredth implant, and by then, you will feel completely at ease with the process. The data, both from clinical trials and real-world experience, consistently show that leadless pacemakers are just as safe, if not safer, than traditional transvenous ones. So, trust the evidence!
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