Leadless pacing: also an option for the young?

Abstract

Leadless pacemakers (LPs) were designed to overcome lead-and pocket-related complications. To date, no randomized clinical trials have been performed, but observational trials in large patient groups have demonstrated adequate safety and efficacy up to two years after implantation(1-3). Hence, LPs are incorporated in the latest guidelines on pacing therapy and should be considered for selected patients(4). Young age is currently regarded as an argument against leadless pacing. On the one hand, this is due to limited data on real-world long-term battery longevity and replacement strategies. Retrievability of LPs with a screw-in helix fixation mechanism was acceptable (long-term success rate >80%(5)), but reliable data on retrievability of LPs with a tine-based fixation mechanism is expected in the next years. Co-implantation is feasible with two LPs, but has not yet been describedin vivo with three of more LPs. On the other hand, data on safety and efficacy in the young is scarce. For instance, the patients studied in trials were typical single-chamber ventricular pacemaker recipients, i.e. well over 70 years old. To date, it is unknown whether the results of those trials also apply to young patients.