Leadless
Pacemaker

What is a leadless pacemaker?

Traditional pacemakers consist of a generator (implanted under the skin near the collarbone) connected to one or two leads (thin wires) that run through veins into the heart. The leads deliver electrical impulses from the generator to the heart muscle.

A leadless pacemaker eliminates all of this external hardware. It is a single, self-contained capsule about the size of a large vitamin pill — implanted directly inside the right ventricle through a catheter inserted in the groin. No chest incision. No pocket. No leads.

What are the advantages?

• No surgical pocket under the skin — no visible bulge, no wound
• No leads — eliminates the most common source of pacemaker complications (lead fractures, lead infections, lead dislodgements)
• No chest incision — procedure is performed entirely through the groin
• Shorter recovery time compared to traditional pacemaker implantation
• MRI-compatible
• Excellent option for patients with prior pacemaker infections or difficult venous anatomy

Who is a candidate for a leadless pacemaker?

• Patients who need single-chamber right ventricular pacing (the most common pacing indication)
• Patients with prior pacemaker pocket infections
• Patients with limited venous access making traditional lead placement difficult
• Patients who prefer to avoid a visible device under the skin
• Patients at high risk of surgical wound complications

What devices are available?

• Micra VR (Medtronic): Single-chamber ventricular leadless pacemaker. The original leadless device with a well-established track record.
• Micra AV (Medtronic): Uses accelerometer-based sensing to detect atrial activity and synchronize ventricular pacing — providing more physiologic pacing without an atrial lead.
• AVEIR VR (Abbott): Single-chamber leadless pacemaker designed to be retrievable and exchangeable.
• AVEIR DR (Abbott): A dual-chamber system using two separate leadless devices — one in the right atrium and one in the right ventricle — that communicate wirelessly to pace in a synchronized, coordinated fashion. This is a major advance, allowing true dual-chamber leadless pacing. Both devices are designed to be extractable when needed.

What happens when the battery runs out?

This depends on the device platform.

With the Micra (Medtronic), when the battery is depleted a new device is implanted alongside the old one. The original device is simply deactivated and left in place permanently — it poses no risk but does remain inside the heart.

With the AVEIR (Abbott), the approach is different and reflects a key design advantage. The AVEIR was specifically engineered to be extractable. When the battery reaches end of life, the old device is retrieved and removed, and a new AVEIR is implanted in its place. There is no accumulation of old hardware left inside the heart over time.