Ten Years of Leadless Cardiac Pacing (JACC November 2024-2)-Article: Ten Years of Leadless Cardiac Pacing

Article: Ten Years of Leadless Cardiac Pacing

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The review article elaborates on the advancements and current status of leadless pacemakers (LPs), which have been developed and refined over a decade. These LPs are implanted directly in the heart without the need for leads or a subcutaneous pocket, providing an alternative to traditional pacemakers that come with inherent complications such as lead fractures and infections. Since the first implantation in 2012, LPs have become a recognized treatment due to technology improvements and accumulating evidence regarding their safety and efficacy.<br /><br />The article discusses several types of single-chamber LPs, such as the Micra VR and Aveir VR, which have proven mostly effective and safe, with fewer short- and long-term complications compared to traditional transvenous pacemakers. However, there remain challenges, including complications like perforation during insertion. The review also highlights more recent developments like dual-chamber LPs, which include an atrial component for better atrioventricular synchrony but come with their complications and learning curves for implantation.<br /><br />The future developments in LP technology, like energy-harvesting LPs and systems capable of communicating with implantable defibrillators, aim to expand the applicability and functionality of LPs further. Despite the high cost and needing more long-term retrieval experience, LPs offer significant advantages for patients who have high risks of complications from traditional pacemakers, like those with prior infections or without suitable venous access.<br /><br />As LP technology continues to evolve, these devices are poised to become more widely used, offering enhanced pacing options with lowered complication risks, and addressing specific conditions that traditional pacemakers cannot ideally manage.

Keywords

leadless pacemakers

LP advancements

traditional pacemakers

Micra VR

Aveir VR

dual-chamber LPs

atrial synchrony

energy-harvesting LPs

implantable defibrillators

pacing technology