Comparative Performance, Procedural Characteristics and Safety of Micra Versus Aveir Leadless Pacemakers: Systematic Review

BACKGROUND: Leadless pacemakers (LPs) are developed to avoid pocket- and lead-related complications of transvenous pacing systems, but direct comparative data between two single chamber LP, namely Micra VR and Aveir VR are scarce. METHODS: A systematic review and meta-analysis of studies directly comparing Micra VR and Aveir VR was performed. PubMed, Embase, and Scopus were searched through November 2025. Eligible studies reported electrical performance, procedural metrics, or periprocedural complications. RESULTS: Four observational studies, including 757 patients (363 Aveir, 394 Micra), met the inclusion criteria, with follow-up of 1-6 months. At implantation, Aveir showed slightly higher pacing thresholds (mean difference (MD) 0.18 V; 95% CI 0.09-0.26), while impedance and R-wave amplitude were similar. In follow-up, pacing thresholds showed no significant difference between devices, whereas Micra demonstrated higher R-wave amplitudes (MD -1.18 mV; 95% CI -2.29 to -0.07). Fluoroscopy time was longer with Aveir (MD 2.89 min; 95% CI 0.69-5.08), but total procedure duration did not differ significantly. Rates of device dislodgement, pericardial effusion/tamponade, and overall periprocedural complications were low and not statistically different between the two systems. CONCLUSION: Micra VR and Aveir VR demonstrate generally comparable short-term electrical performance, procedural efficacy, and safety. Minor differences in thresholds, sensing, and fluoroscopy time are likely indicative of design and workflow characteristics. Larger, well-controlled randomized studies with extended follow-up periods are necessary to establish long-term performance.