Leadless pacemakers: A review of communication methods, energy management, and clinical applications

Leadless pacemakers have emerged as a mainstream clinical solution, and their communication capabilities, crucial for reliable pacing and device monitoring, continue to evolve. This review systematically examines the fundamental principles of leadless pacemaker communication systems, current design requirements, existing challenges, and future development trends. We outline the bidirectional communication mechanism between leadless pacemakers and external programmers through wireless technologies, focusing on radio-frequency field communication coupled with load modulation techniques to optimize energy efficiency and transmission reliability. Additionally, we analyze the role of artificial intelligence in adaptive communication protocols and explore the clini cal potential of remote monitoring and control systems. This comprehensive analysis aims to serve as a reference for the development of communication architectures for leadless pacemakers.