Background: Leadless pacemakers are miniaturized intracardiac pacing devices designed to overcome complications associated with conventional transvenous pacemakers, including pocket infection, lead fracture, venous occlusion, and lead dislodgement.

Objective: To review the clinical outcomes, safety profile, procedural considerations, complications, and future directions of leadless pacemaker therapy.

Methods: This narrative review summarizes clinical trials, registries, observational studies, and contemporary electrophysiology practice recommendations regarding leadless cardiac pacing.

Results: Leadless pacemakers demonstrate high implantation success, stable pacing thresholds, low infection rates, and reduced lead- and pocket-related complications. Current use is strongest for patients requiring single-chamber ventricular pacing, particularly those with atrial fibrillation and bradycardia, high infection risk, limited venous access, or prior device infection.

Conclusion: Leadless pacemakers represent a major advancement in cardiac rhythm management. While they offer important safety advantages over conventional systems, careful patient selection, procedural expertise, and long-term surveillance remain essential.