Leadless Pacemakers: Recent and Future Developments

Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implant and long-term follow-up. Since initial market release, however, there have been registry and single-center reports documenting improvements in implant technique, reduced complication rates, and new patient populations studied.

Most studies have demonstrated a further reduction in complication rates and safe implant in those on continuous anticoagulation. Perforation rates are decreasing but still occur and risk factors include BMI < 20 kg/m2, age ≥ 85 years, females, history of heart failure, indication not including atrial fibrillation, and chronic lung disease. Device infections are exceedingly rare, even in those undergoing infected transvenous devices at the same time. For appropriate patients, leadless pacing is a safe and reasonable option, especially if atrial-based sensing or pacing is not needed. Future iterations may include VDD pacing, atrial pacing, dual-chamber pacing, biventricular pacing, and device-device communication.