Leadless Pacing: Therapy, Challenges and Novelties.

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.

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Copyright © 2023, Radcliffe Cardiology.

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Disclosure: NW receives fellowship funding from the British Heart Foundation (FS/CRTF/22/24362). VM has received fellowship funding from Abbott. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812,PG/13/37/30280, SP/18/6/33805), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics, EBR Systems and MicroPort outside of the submitted work. JMB recieves research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems and Biosense Webster outside of submitted work. FDV has no conflicts of interest to declare. Funding: The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z).