Evolution of leadless pacemaker technology

Abstract Cardiac pacemakers have revolutionized the management of heart rhythm disorders since their introduction in the mid-20th century. They have played a crucial role in the management of several clinical conditions, from symptomatic bradyarrhythmia to electrical and/or mechanical dyssynchrony. Conventional cardiac pacemakers have significantly evolved over the last several decades. However, a critical limitation has been the presence of a generator pocket and endovascular leads connecting the pulse generator to cardiac tissue. While leads are essential to the pacemaker system by transmitting electrical impulses, they impose several significant risks that include venous thrombosis, device-associated endocarditis, and lead malfunction (mainly due to lead fracture, insulation failure, and macro- or micro-dislodgement), whereas the generator pocket can be the origin of a systemic device infection. The development of leadless pacemakers inaugurated a new era in cardiac pacing, eliminating many of the risks associated with traditional transvenous pacemakers. Leadless pacemakers are small, self-contained devices, which are fundamentally able to pace the heart without the need for a pocket and endovascular leads.