Around 200,000 pacemakers are implanted annually in the U.S. Among VVI implants, leadless devices rose from ~1% (2016) to ~43% by 2020. For all pacemakers (including dual-chamber and CRT), transvenous still predominates (>50%).
Leadless Pros: No pocket/leads, lower infection, better cosmetic outcome, avoids tricuspid crossing, promising AV synchrony.
Leadless Cons: Higher cost, limited long-term data, pericardial risk, retrieval more complex.
Transvenous Pros: Established reliability, lower cost, easy generator swap, decades of evidence.
Transvenous Cons: Pocket/lead infection risk, visible bump, tricuspid regurgitation, extraction hazards.