Procedure

Leadless Pacemaker

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Leadless Pacemaker

  • See Also
  1. Pacemaker
  • Background
  • Development
  1. Year 1970: Leadless Pacemaker concept proposed by Dr. Spickler
  2. Year: 2012: First Leadless Pacemaker implanted - ventricular pacing only (Nanostim, Micra)
  3. Year 2020: AV Synchronous leadless pacing
  4. Year 2023: Dual chamber leadless pacing
  5. Year 2025: Cardiac resynchronous leadless pacing
  • Mechanism
  1. Small device (2.6 x 0.7 cm), the size of a bullet, with hooks at one end
  2. Initial devices have primarily been introduced into the right heart wall via introducer sheath catheter
  • Complications
  1. Major complication rate: 4%
  2. Myocardium perforation: 1.6%
  3. Catheterization complications (e.g. groin Hematoma)
  4. Dislodgment: 0.06%
  5. Infection is rare
  • Imaging
  1. Chest XRay Findings
    1. Identify pacer type
    2. Evaluate for dislodgment
  2. Bedside Ultrasound (POCUS) Findings
    1. Percicardial effusion
  • Management
  1. Pacemaker malfunction
    1. Leadless Pacemakers lack a magnetic switch and do not respond to external magnets
    2. May require emergency pacing (e.g. Epinephrine, external pacing, Transvenous Pacemaker)
  • References
  1. Swaminathan and Hedayati (2026) Leadless Pacers, EM: Rap, 2/9/2026
  2. Epstein (2025) Eur Heart J Suppl 27(Suppl 2):ii3-ii7 +PMID: 40135100 [PubMed]