Leadless Pacing: Therapy, Challenges and Novelties

Nadeev Wijesuriya; Felicity De Vere; Vishal Mehta; Steven Niederer; Christopher A Rinaldi; Jonathan M Behar

doi:10.15420/aer.2022.41

Leadless Pacing: Therapy, Challenges and Novelties

Arrhythm Electrophysiol Rev. 2023 Apr 13:12:e09. doi: 10.15420/aer.2022.41. eCollection 2023.

Authors

Nadeev Wijesuriya^{1

2}, Felicity De Vere^{1

2}, Vishal Mehta^{1

2}, Steven Niederer¹, Christopher A Rinaldi^{1

2}, Jonathan M Behar^{1

2}

Affiliations

¹ School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
² Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Abstract

Leadless pacing is a rapidly growing field. Initially designed to provide right ventricular pacing for those who were contraindicated for conventional devices, the technology is growing to explore the potential benefit of avoiding long-term transvenous leads in any patient who requires pacing. In this review, we first examine the safety and performance of leadless pacing devices. We then review the evidence for their use in special populations, such as patients with high risk of device infection, patients on haemodialysis, and patients with vasovagal syncope who represent a younger population who may wish to avoid transvenous pacing. We also summarise the evidence for leadless cardiac resynchronisation therapy and conduction system pacing and discuss the challenges of managing issues, such as system revisions, end of battery life and extractions. Finally, we discuss future directions in the field, such as completely leadless cardiac resynchronisation therapy-defibrillator devices and whether leadless pacing has the potential to become a first-line therapy in the near future.

Keywords: Leadless pacing; cardiac resynchronisation therapy; conduction system pacing.

Publication types

Review