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Comparative Analysis of Extraction Complications in Transvenous Versus Leadless Pacemakers.

Abdullah Sahyouni1, Antonella Jimenez1, Johny Alrahal1

  • 1Internal Medicine, Blake Medical Center, Bradenton, USA.

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|June 8, 2026
PubMed
Summary

Leadless pacemakers (LPs) have fewer extraction complications than transvenous pacemakers (TPs). LPs are favored for their minimally invasive approach, reducing risks like infection and improving patient recovery.

Keywords:
cardiac implantable electronic device (cied)cardiac pacemakerscardiac rhythm devicescardiology devicesinternal medicine-cardiologylife threatening arrhythmiapacemaker extractionpacemaker lead displacementpermanent pacemaker implantation (ppm)ppm complication

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Pacemakers, or cardiac implantable electronic devices (CIEDs), regulate heart rhythm.
  • Transvenous pacemakers (TPs) use pacing leads, while leadless pacemakers (LPs) are implanted directly in the right ventricle.
  • Pacemaker extraction may be necessary due to infection, malfunction, or upgrades.

Purpose of the Study:

  • To analyze and compare the incidence and severity of extraction complications between TPs and LPs.
  • To evaluate the safety and efficacy of pacemaker extraction procedures for both device types.

Main Methods:

  • A comprehensive narrative review of studies on pacemaker extractions was conducted.
  • The PubMed database was searched using keywords such as "transvenous pacemaker," "leadless pacemaker," "pacemaker extraction," "device infection," and "bacterial complications."
  • 97 original articles focusing on pacemaker extractions were included after excluding irrelevant studies.

Main Results:

  • Both TP and LP extractions demonstrated high procedural success and low mortality rates.
  • TPs presented unique risks, including arteriovenous fistula, tricuspid dysfunction, and atrial tearing, not associated with LPs.
  • LPs showed fewer extraction complications, shorter extraction times, and better post-operative recovery compared to TPs, partly due to their smaller size and minimally invasive approach.

Conclusions:

  • Leadless pacemakers (LPs) are associated with fewer extraction complications than transvenous pacemakers (TPs).
  • The minimally invasive nature of LPs reduces risks and improves recovery outcomes.
  • Future large-scale studies are recommended to further validate these findings on extraction complication differences.