In the wireless era: leadless pacing

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system that serves as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also an Achilles tendon that directly causes most device complications both acutely during implant and chronically years afterwards. Both durability and optimization of the stimulation site are important areas of improvement for manufacturers and implanters. Elimination of the pacing lead and the utilization of other means for energy transfer is the only way to avoid lead complications and allow a better choice of stimulation site. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans in acute studies. This has aroused intense interest in the field of cardiac pacing. With concerted effort from the profession and the industry, leadless pacing may indeed become a realizable concept.