New Approach Concept of Leadless Pacemaker Implantation for Smaller Hearts

reported to reduce overall complications by 48%. 3 Although the frequency of acute complications internationally and in Japan is low at 3-4%, 4,5 cardiac perforation and pericardial effusion occur in 1-2%, 4-6 and these complications can be severe.In addition, real-world data from the USA are 16% for acute complications and 5% acute deaths, 7 and acute events are potentially fatal.Thus, although the current implantation of leadless pacemakers is safe and has shown T he main use of leadless pacemakers has been for patients with bradycardic atrial fibrillation and older patients, but recently they are being considered for use in younger patients who are at higher risk of infection, have a history of infection, or have endstage renal failure which vessel sparing is desired. 1 The utility of these pacemakers is high and the Micra CED study reported that they have a similar all-cause mortality rate and significantly lower rates of remote complications, device re-intervention, infection, and heart failure hospitalization as transvenous pacemakers. 2 Furthermore, leadless pacemakers have been