Leadless pacing: Technology, techniques, and emerging options

Leadless pacemakers offer several advantages over transvenous pacemakers. They mainly reduce lead and pocket related complications which result in a reduction of re-intervention and infection rates (Graphical abstract). However, leadless pacemakers are not without drawbacks. Implantation of leadless pacemakers present a higher risk of pericardial perforation compared to its transvenous counterpart. Also, the leadless pacing technology is relatively new, and little is known about the best approach to manage these devices at the time of an upgrade or when the battery is at end of life. A modular approach for leadless pacing is emerging as a logical way to minimize the amount of hardware in the heart while preserving the ability to upgrade a single chamber device to a dual chamber (Graphical abstract). This review aims to present an overview of the different leadless pacemakers, indications for implantation, guidance on extraction while highlighting the advances made in the field.