During replacement procedures, an incision is made at the device location. The leads are then briefly disconnected from the heart device, and the old device is removed. After the leads are tested to confirm they are functioning properly, a new device is connected to those leads. The new device is then placed in the existing pocket and the incision is closed.

Leadless pacemakers are generally not removed when the battery runs low. Instead, when a new leadless pacemaker is needed, the device is turned off and may be left inside the heart before a new leadless or traditional pacemaker system is implanted. A doctor will determine what is best for each individual situation.