Leadless Pacing: Therapy, Challenges and Novelties

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.

Perioperative Considerations for Modern Leadless Pacemakers

“…Patients with ESRD often have compromised upper extremity venous systems from multiple prior access attempts or arteriovenous fistulas that preclude transvenous pacemaker leads. 3 In this population, the insertion of a leadless pacemaker through the femoral vein offers a viable alternative. 45…”

“…2 With an improved side effect profile over traditional pacemakers and expanding capabilities for atrioventricular synchrony, these exciting advances in pacemaker technology provide unique challenges for anesthesia providers. 3,4 While data for the safety of these devices continues to grow, societal guidelines for perioperative care have yet to be developed. 5,6 We present a review of the current literature to provide the best opportunity to safely care for patients with leadless pacemakers in the perioperative period.…”

Editorial: Electrical management of heart failure: shaping the future of cardiac pacing and electrophysiology

“…Finally, as technological advancements foster novel pacing pathways, adopting leadless pacemakers could offer broader therapeutic applications in HF management, complementing existing strategies to optimize cardiac function and enhance patient quality of life without the traditional lead-wire system (9).…”