 Dr. Rashneesh Sardana, I am the head of pacing and electrophysiology department at the Manipalat Institute, Dwarka New Delhi. I am going to discuss about the pacemakers and their advancements. One of the advancements in pacing has been an introduction of a leadless pacemaker. A pacemaker by and large is devised to take care of slow heart rates. If a patient's heart rate drops to below a certain degree, patient life can be at risk or they can have multiple blackout episodes. So pacemakers are implanted inside the body where it delivers a current in case the patient's own heart electric impulses not generated. So it will not allow the heart rate to fall. Conventionally the pacemakers are small devices which are implanted under the clavicle near the shoulder and then it has a lead which goes through the venous system into the heart and delivers the impulse in the heart. This is the conventional system which is implanted for the last 50 years. However certain patients do not have access to entering the heart and putting the lead into the heart ventricle. So the new leadless pacemaker is a small capsule like a pacemaker which is generally implanted in the right side of the heart through the leg in case in place of the access through the shoulder to near the shoulder veins. So it is a capsule which is taken into the heart through the leg into the heart and placed there and gets fixed inside and it again has a battery and a circuit. The purpose is to deliver the current inside the heart. So here there is no device which is implanted here. There is no lead. So the device is a small capsule as a side which is placed inside the heart does the same job except here it is usually a single chamber pacemaker because this is one capsule which is placed inside the right ventricle and places the ventricle. Whereas the pacemakers which are implanted in the shoulder near the shoulder joint usually are due chamber where we have two leads which take care of a normal physiological where it has the capacity to place the upper chamber and the lower chambers. The patients who need a leadless pacemaker are usually elderly patients or patients, children when the access or there is no route to enter the heart through the shoulder veins, the subclavian veins or they have infection and there is no site where the pacemaker can be implanted. So usually they are less than 1% of the patients who require a leadless pacemaker.