Leadless Pacemaker: Report of the First Experience in Hawai'i.

We had the opportunity to implant the first leadless pacemakers in Hawai'i. This device represents a major change in pacemaker technology. This is a report of the first five cases and a review of the literature. All these devices were implanted via femoral venous access (versus conventional upper chest axillary/subclavian/cephalic routes), with an unique fixation mechanism allowing direct attachment to the ventricular myocardium (dispensing the usage of long transvenous electrode leads). The miniature generator can is over an order of magnitude smaller and lighter than the currently available ones. This article provides an understanding of the device design, implantation technique, the advantages and limitations, and the potential of this new pacemaker.