New Pacing Guidelines 2021-Leadless Pacing

At the ESC Congress in 2021 the new pacing guidelines were introduced. Particularly the recommendations and indications for leadless pacer implantation were of interest. Two different leadless pacing systems are currently commercially available: The Micra VR system enabling an asynchronous pacing mode and the Micra AV. The latter allows an AV-synchronous stimulation mode. Both systems are deployed transvenously via the femoral vein using a steerable catheter system. Intermittent bradycardia in the setting of persistent or permanent AF is the main indication for the Micra VR. In addition, the introduction of the Micra AV broadened the indication spectrum for patients in sinus rhythm and sporadic AV-block. However, the new guidelines only state a class IIa, level B recommendation for implantation of leadless pacer in a distinct group of patients.