[Leadless pacemakers : current evidence and future perspectives]

Leadless pacemakers represent a major advance in cardiac pacing. Unlike conventional systems, they are entirely implanted within the heart, without transvenous leads or a subcutaneous generator, thereby substantially reducing the risks of infection, lead fracture, and device displacement. First introduced in 2012 with the Nanostim™ (St. Jude Medical®), this technology subsequently evolved with the market introduction of the Micra™ (Medtronic®), which is easy to implant and has a safety profile comparable to that of conventional pacemakers. More recently, the AVEIR™ system (Abbott's®) has marked a further milestone by enabling leadless dual-chamber pacing with direct «implant-to-implant» communication between the atrial and ventricular modules. This evolution paves the way for more complex leadless pacing strategies comparable to conventional systems. In addition, this latest model allows device retrieval and repositioning, overcoming some of the limitations of earlier generations.