Leadless Pacemaker

Aka: Leadless Pacemaker

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II. 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

III. 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

IV. 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

V. Imaging

  1. Chest XRay Findings
    1. Identify pacer type
    2. Evaluate for dislodgment
  2. Bedside Ultrasound (POCUS) Findings
    1. Percicardial effusion

VI. 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)

VII. 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]

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