Nanostim leadless pacemaker system: A longer waiting period after active fixation may reduce unnecessary repositioning

Key Teaching Points•Compared to conventional pacemaker systems, pacing thresholds in the Nanostim leadless pacemaker showed greater magnitude of improvement of pacing threshold.•Even if an initial pacing threshold is high, a longer waiting period may lead to significant reduction of the pacing threshold.•The unique behavior of the Nanostim pacemaker system is likely owing to the difference in the size of the helix and the position of the anode compared to traditional active-fixation transvenous leads. •Compared to conventional pacemaker systems, pacing thresholds in the Nanostim leadless pacemaker showed greater magnitude of improvement of pacing threshold.•Even if an initial pacing threshold is high, a longer waiting period may lead to significant reduction of the pacing threshold.•The unique behavior of the Nanostim pacemaker system is likely owing to the difference in the size of the helix and the position of the anode compared to traditional active-fixation transvenous leads.

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