Key result
Leadless pacemakers cut 36-month major complications ~53% compared to transvenous systems.
Why the study?
Conventional transvenous cardiac pacing systems carry lead and subcutaneous pocket complications, whereas fully intracardiac leadless devices eliminate these components but have limited battery capacity due to their small size.
Do leadless pacemakers and emerging wireless power transfer pacing systems reduce device-related complications while maintaining pacing efficacy compared to conventional transvenous pacemakers in patients with bradyarrhythmias?
Do leadless pacemakers and emerging wireless power transfer pacing systems reduce device-related complications while maintaining pacing efficacy compared to conventional transvenous pacemakers in patients with bradyarrhythmias?
Leadless pacemakers significantly reduce chronic complication, infection, and reintervention rates compared to transvenous systems without altering all-cause mortality, while physically separating the energy source via wireless power transfer offers a potential conceptual solution to battery size limitations that requires clinical validation.
Answers are grounded in this paper and cite their sources.
May support leadless pacing to reduce complications; leaves open need for randomized trials to guide adoption.
Background and aim. Cardiac pacing has evolved from conventional transvenous (lead-based) systems to fully intracardiac leadless devices. Transvenous systems are reliable and versatile, but their main drawback is complications related to the lead and the subcutaneous device pocket. Leadless systems removed both components, yet introduced a new constraint: because the device is small, its battery capacity is limited. This article reviews established and emerging pacing technologies using quantitative data and discusses an approach in which the energy source and the intracardiac stimulating component are physically separated. Methods. A narrative literature review was performed in PubMed and IEEE Xplore for 2005–2025, covering clinical trials, large registries, international guidelines and peer-reviewed engineering papers. Results. Early complication rates of transvenous systems range from 4.8% to 12.4%, and most late complications are lead-related [3]. With leadless systems, major complications at 36 months are almost halved (4.1% vs 8.5%) [19]; in a large population, chronic complications were 32% lower and reinterventions 41% lower [15]. At the same time, leadless implantation carries its own, mainly procedural risks (e.g. pericardial effusion 0.4–1.5%) [6,8]. In the dual-chamber system, atrioventricular synchrony was achieved in 97.3% of patients [13]. Conclusion. Technological progress aims to reduce lead-related complications, miniaturise devices and expand functionality. Separating the energy source from the stimulating component is one possible way to overcome the battery limitation of leadless systems, although its clinical value has not yet been established.
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Karabaki et al. (2026) conducted a review in Bradyarrhythmias, sinus node dysfunction, and cardiac conduction disorders. Leadless cardiac pacemakers (Micra VR/AV, AVEIR VR/DR) and wireless power transfer concepts vs. Conventional transvenous (lead-based) pacemaker systems was evaluated on Major complications at 36 months (cited from Micra registry vs transvenous systems) (HR 0.47, 95% CI 0.36-0.61). Leadless pacemakers nearly halved 36-month major complications compared to transvenous systems and reduced 3-year reinterventions by 41%.
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