Concierge cardiology · London
Leadless pacemakers in London, by a consultant electrophysiologist.
A miniature, self-contained pacemaker placed directly inside the right ventricle — no chest pocket, no leads, no shoulder scar. Micra AV, Micra VR and Abbott Aveir all on the table, with an honest steer on whether it is right for your rhythm.
Why patients choose us
- 01
A consultant electrophysiologist, in a cath lab
Not a general cardiologist, not a training list. A named EP consultant who implants leadless devices routinely, in a proper cath lab.
- 02
The right device for your rhythm
Micra VR, Micra AV and Aveir sit on the table. Which one — and whether a leadless is even the right choice — is settled before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private leadless pacemaker costs in the UK.
Indicative ranges across our partner cath labs. NHS funding applies where BHRS criteria are met. Send the details and we quote firm figures across two or three options.
In short
A Micra AV in our network: £17,000–£22,000, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Leadless pacemaker (Micra VR, single-chamber) | £15,000–£20,000 | 30–60 min | Same day |
| Leadless pacemaker (Micra AV, AV-synchronous) | £17,000–£22,000 | 45–75 min | Same day |
| Leadless dual-chamber system (Abbott Aveir) | £20,000–£25,000 | 60–90 min | Same day / 1 night |
| EP consultation and pacing assessment | £250–£450 | 45 min | Same visit |
| Device check and remote monitoring set-up | £150–£300 | 20 min | Same visit |
| End-of-life device: turn off + new implant | £15,000–£22,000 | 60–90 min | Same day |
Prices vary by centre, by which electrophysiologist does the case, by which device is chosen, and by whether an overnight stay is used. We come back with a firm quote within one working day.
The problem
The right device, the right centre, the right advice.
A leadless pacemaker is a beautiful piece of engineering — but not every bradycardia belongs in one. The mistakes we see are the wrong indication, the wrong device family, and centres that only offer one manufacturer. We fix all three before you commit.
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Not sure it fits your rhythm?
If you need atrial pacing, CRT or an ICD, a leadless is the wrong answer. We say so before you agree to it.
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Worried about the pocket?
Prior infection, dialysis, immunosuppression, thin skin — the femoral leadless route sidesteps every pocket risk.
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Want it done properly?
A named electrophysiologist, a BHRS-accredited cath lab, and Micra AV, Micra VR and Aveir all in the room.
The journey
From enquiry to remote monitoring — what happens, in order.
One electrophysiologist from first message to long-term device follow-up.
Phase 1 · Before your implant
Concierge, off-stage for you
Phase 2 · On the day
A few hours in the cath lab
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, ECG or Holter results if you have them, and whether you already have a pacing recommendation from your cardiologist.
- 02
Before
We come back with a recommendation
Within one working day: whether a leadless pacemaker fits your rhythm, which device, and an indicative price. If a transvenous device or CRT is more appropriate, we say so.
- 03
Before
We arrange the implant
Usually within one to two weeks. Blood thinners are reviewed with the EP team and never stopped without advice. Fasting instructions and groin-prep guidance are sent to you.
- 04
On the day
Arrival at the cath lab
Admission, consent and a chat with the electrophysiologist and anaesthetist. Local anaesthetic to the groin, plus light sedation.
- 05
On the day
The implant itself
30 to 90 minutes in a cath lab. Femoral vein access, catheter delivery to the right ventricle, device deployed with four tines, pacing thresholds confirmed, catheter withdrawn.
- 06
On the day
Home the same day or next morning
Pressure dressing on the groin for 4–6 hours, then bed rest. Most patients go home the same evening; some stay one night for observation.
- 07
After
Recovery and device check
Back to normal life within a week. No arm or shoulder restrictions. Device check at 6 weeks, then remote monitoring every 3–6 months.
Typical end-to-end: 1–2 weeks from enquiry to implant. Back to normal life: within a week.
When it helps
When a leadless pacemaker is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Symptomatic bradycardia
A slow heart rate causing dizziness, blackouts, breathlessness or fatigue — with a pacing indication confirmed on ECG or Holter.
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AV block (heart block)
Second- or third-degree AV block where single-chamber ventricular pacing is the right fit — Micra AV can add sensed atrial coordination.
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Chronic AF with slow ventricular rate
Permanent atrial fibrillation with pauses or a slow response — a classic single-chamber ventricular pacing indication.
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Sinus node dysfunction
Sick sinus syndrome where atrial pacing is not required, or where the atrial lead risk outweighs benefit.
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Previous device infection
A prior pocket infection or endocarditis, cardiac transplant, dialysis, immunosuppression — situations where a subcutaneous pocket is best avoided altogether.
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Cosmesis or lifestyle
No chest scar, no device outline, no lead across the shoulder — favoured by athletes, climbers, and patients who dislike the visible pocket.
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Limited venous access
Upper-extremity DVT, prior lead complications, dialysis fistula concerns — the femoral route sidesteps the subclavian system entirely.
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Red flag: syncope with slow pulse
Blackouts with a documented slow rhythm are urgent — same-day A&E, not a clinic booking. Once stable, the pacing route can be discussed properly.
Device options
Leadless is not always the answer.
What each device on the table actually does — and where a conventional transvenous pacemaker, CRT or ICD still wins.
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Medtronic Micra VR
The original leadless — single-chamber right-ventricular pacing (VVI/VVIR). Around 26mm long, 7mm across. The workhorse for chronic AF with slow rate.
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Medtronic Micra AV
Leadless VR with an accelerometer that senses atrial contraction, delivering AV-synchronous pacing (VDD) without an atrial lead. Suits AV block with normal sinus rhythm.
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Abbott Aveir VR
Single-chamber leadless, retrievable design, mapping capability before final fixation. An alternative when a Micra does not fit or a second-generation device is preferred.
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Abbott Aveir DR (dual-chamber)
Two communicating leadless devices — one in the right atrium, one in the right ventricle — delivering true dual-chamber pacing (DDD) without any leads at all.
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Transvenous single-chamber (VVI)
Still appropriate where femoral access is difficult, RV anatomy is unusual, or a leadless would be borderline. We say so honestly if that is your case.
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Transvenous dual-chamber (DDD)
The standard for sinus node dysfunction requiring atrial pacing, or where a leadless dual-chamber system is not indicated. A conventional pocket-and-lead device.
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CRT-P / CRT-D (biventricular)
For heart failure with a wide QRS — a leadless does not deliver cardiac resynchronisation. A conventional CRT device is the right answer.
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ICD (defibrillator)
If you need shock therapy for ventricular arrhythmia, a leadless pacemaker cannot replace it. A transvenous or subcutaneous ICD is required.
Our vetted London network
A small panel of electrophysiologists, we picked them.
Consultant electrophysiologists at BHRS-accredited centres across London. Not listed publicly — introductions are made privately, once we understand your rhythm.
Selection criteria
How we choose every electrophysiologist in our network.
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Consultant electrophysiologists with high leadless implant volume
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BHRS-accredited implanting centres with on-site cardiac surgery cover
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Micra AV, Micra VR and Aveir all available — not just one manufacturer
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Remote monitoring and long-term device follow-up included
Safety and recovery
What to expect afterwards — honestly.
A leadless implant is a shorter, gentler procedure than a transvenous pacemaker — but the risk profile is different, not absent. Here is what changes, and what does not.
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A cath-lab procedure under LA + sedation
Local anaesthetic to the groin, plus light sedation. You are comfortable but not asleep. General anaesthesia is rarely needed.
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No pocket, no lead — most pocket risks vanish
No pocket infection, no lead dislodgement, no lead fracture, no subclavian vein occlusion, no pneumothorax, no pocket haematoma. The MICRA registry showed a 63% reduction in major complications at 12 months.
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Cardiac perforation is the specific risk
Around 1–1.5% of implants — slightly higher than transvenous. Usually self-limiting or treated with pericardial drainage in the same session.
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Groin access matters
Femoral vein puncture means a small risk of haematoma, pseudoaneurysm or AV fistula (1–2%). Pressure dressing for 4–6 hours, then bed rest.
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Battery life 10–15 years
Comparable to transvenous devices, without any lead-related failures over that time. Remote monitoring flags depletion months in advance.
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End-of-life: leave in place, add a new one
When the battery is spent the device is programmed off and left in the ventricle. A new device is implanted alongside — up to three devices safely reported in the same RV.
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No arm or shoulder restrictions
Because there is no lead crossing the shoulder joint, there is nothing to dislodge. Climbers, swimmers and racquet players return to sport within a week.
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What it cannot do
A leadless does not pace the atrium (except Aveir DR), does not deliver CRT, and does not shock. If you need any of those, a different device is the right answer.
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Red flags
Fever, groin swelling that grows, chest pain, breathlessness or blackouts after implant — call the clinic or A&E the same day.
Reading your implant note
Your implant note in four parts. Read the last one first.
Whichever device was used, the note the electrophysiologist sends you keeps to the same shape.
A quiet reminder
Device programming language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your device check, just ask.
- 01 Header
Indication and device chosen
Why the implant was done — AV block, chronic AF, sinus node dysfunction — and which device (Micra VR, Micra AV, Aveir) was implanted.
- 02 Technique
Access, deployment and pacing thresholds
Femoral vein used, delivery catheter, tine deployment site on the RV septum, and the pacing threshold, sensing and impedance measured at implant.
- 03 Findings
Complications and observations
Any pericardial effusion, femoral access issue, ectopy during deployment, or need for repositioning before final fixation.
- 04 Impression
Programming, follow-up and remote monitoring
Read this first: the programmed mode (VVI, VDD, DDD), when to return for the 6-week check, and the remote monitoring plan for the years ahead.
Recognised by major UK insurers
Cover for leadless pacemaker implantation varies by insurer — usually funded where BHRS criteria are met and the indication is clearly documented. We confirm cover before booking.
Frequently asked
Everything we get asked about leadless pacemakers.
Quick answers on candidacy, procedure, battery life, cost, risks and recovery.
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What is a leadless pacemaker and how is it different?
A leadless pacemaker is a self-contained device around 25–30mm long that sits directly inside the right ventricle. There is no chest pocket and no lead running through the veins to the heart. A transvenous pacemaker has a generator implanted under the skin below the collarbone, with one or two leads threaded down through the subclavian vein.
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Am I a candidate for a leadless pacemaker?
You are a candidate if you need single-chamber ventricular pacing — commonly for AV block, chronic AF with slow ventricular rate, or sinus node dysfunction where atrial pacing is not needed. You are not a candidate if you need cardiac resynchronisation (CRT), a defibrillator (ICD), or dual-chamber pacing (unless Aveir DR is available). The EP team will confirm on ECG, Holter and echocardiogram.
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How is the device implanted?
Through the femoral vein in the groin, under local anaesthetic with light sedation. A long delivery catheter carries the device up to the right ventricle where four tiny tines anchor it into the septal muscle. Pacing thresholds are checked, the catheter is withdrawn, and a pressure dressing is applied to the groin. The whole procedure takes 30 to 90 minutes.
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How long does the battery last?
Typically 10–15 years, comparable to a transvenous pacemaker. Remote monitoring tracks battery status and flags depletion months in advance.
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What happens when the battery runs out?
The old device is turned off and left in place. A new device is implanted alongside it in the same ventricle. Up to three devices have been safely reported in a single right ventricle. Early retrieval (within about a year) is possible but complex; later retrieval is rarely attempted.
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How much does a private leadless pacemaker cost in the UK?
Roughly £15,000–£20,000 for a Micra VR, £17,000–£22,000 for a Micra AV, and £20,000–£25,000 for an Abbott Aveir DR dual-chamber system. NHS funding is available where BHRS criteria are met. We come back with a firm quote within one working day.
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What are the main risks?
The specific risk is cardiac perforation, around 1–1.5% — usually managed with pericardial drainage in the same session. Femoral access can cause haematoma, pseudoaneurysm or AV fistula (1–2%). What you avoid, compared with a transvenous device, is pocket infection, lead dislodgement, lead fracture, subclavian vein occlusion and pneumothorax.
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How quickly do I recover?
Home the same day or the next morning. Pressure dressing on the groin for 4–6 hours, then bed rest for a few hours. No heavy lifting for 3–5 days. Back to normal life within a week — with no arm or shoulder restrictions, because there is no lead crossing the shoulder joint. A transvenous pacemaker recovery is typically 4–6 weeks by comparison.
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When should I see a GP or A&E urgently?
Blackouts with a slow pulse before implant, or fever, groin swelling, chest pain, breathlessness or fainting after implant, are all reasons to seek same-day medical help.
Related treatments
Looking for something else?
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Transvenous pacemaker insertion
Conventional single- or dual-chamber pacing with a chest pocket and leads.
Learn more -
ICD (defibrillator)
Implantable cardioverter-defibrillator for ventricular arrhythmia.
Learn more -
Cardiac resynchronisation (CRT)
Biventricular pacing for heart failure with a wide QRS.
Learn more -
All tests & procedures
Every test and procedure we arrange.
Learn more