CIED-Related Infection Incidence and Clinical Outcomes in Adult Recipients of Leadless Pacemakers

Infections of traditional pacemakers represent a serious complication as they are associated with significant morbidity and mortality. Unlike traditional pacemakers, which have a subcutaneous pocket and transvenous leads, leadless pacemakers have emerged as a promising alternative with a self-contained intracardiac design with significantly lower infection rates. The aim of this systematic review is to synthesize current research on device-related infections in leadless pacemaker recipients. A comprehensive review was performed through PubMed with the following key words, “leadless pacemaker,” “Micra,” “infection,” “PPM,” “conventional pacemaker,” yielding 291 articles. Then, articles were screened for relevance to infection rates among adult recipients of leadless pacemakers versus traditional pacemakers, leading to 45 articles being reviewed for this study. Across the included studies, the incidence of device-related infections in leadless pacemakers was substantially lower compared to traditional transvenous pacemakers, resulting in fewer subsequent device removals. Case reports of patients with leadless pacemaker-associated infections commonly showed presentations with sepsis-like symptoms and bacteremia from unknown origin. While infection rates among leadless pacemaker recipients remain low, procedural complication rates and long-term mortality were slightly higher due to increased rates of severe comorbidities, device deployment challenges, and operator learning curve. These findings suggest that leadless pacemakers are an effective option for high-risk patients. Although low, more attention should be given to leadless pacemaker recipients who present with bacteremia of unknown origin. Future research should focus on the limited number of large-scale, longitudinal studies to further clarify the clinical course of infection among leadless pacemaker recipients.