THE PAST, PRESENT, AND FUTURE OF LEADLESS PACEMAKERS: A NARRATIVE REVIEW OF TECHNOLOGICAL EVOLUTION AND CLINICAL EVIDENCE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6676Keywords:
Leadless Pacemakers, Cardiac Pacing, Transcatheter Pacing, Atrioventricular Synchrony, WiSE-CRTAbstract
Background: Conventional transvenous pacemakers (TVPs) have been the gold standard for bradyarrhythmia management for over six decades. However, transvenous leads and the subcutaneous pocket remain the primary sources of acute and chronic morbidity. Recent large-scale meta-analyses confirm that leadless pacemakers (LPMs) systematically eliminate pocket infections and significantly reduce lead-induced valvular complications.
Aim: The primary objective of this review is to evaluate the clinical safety, efficacy, and technological progression of leadless pacing systems - from first-generation devices (e.g., Nanostim, Micra VR) to contemporary multi-component modular networks, resynchronization therapies, and novel physiologic sensors.
Methods: A comprehensive literature search was performed across major medical databases (PubMed, EMBASE, Cochrane Library) for studies published up to May 2026, focusing on randomized controlled trials, large prospective registries, and clinical updates.
Results: First-generation single-chamber ventricular LPMs demonstrated an excellent long-term safety profile in global registries, outperforming historical transvenous cohorts. The contemporary era is characterized by major structural breakthroughs: advanced accelerometer algorithms for mechanical atrial tracking (Micra AV) and dual-chamber leadless pacing systems (AVEIR DR) utilizing intrabody conductive communication for implant-to-implant (i2i) synchronization. Advanced features now include temperature-based rate response and median battery longevity exceeding 15 years.
Conclusions: Leadless pacemakers have evolved from a niche solution into a primary therapeutic standard. The future of this field relies on multi-component modular networks (pairing LPMs with subcutaneous ICDs), entirely leadless cardiac resynchronization therapy (CRT) utilizing ultrasound acoustics, and the pursuit of energy-harvesting technologies.
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Copyright (c) 2026 Patrycja Sobantka, Aleksandra Woźniak, Aleksandra Straszewska, Szymon Mokrzecki, Matylda Król, Anna Mamach, Katarzyna Aleksandrowicz, Zofia Grodzka, Mateusz Meszka, Ewa Bełc, Karolina Brzezińska
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