Leadless Permanent Pacing: A Single Centre Australian Experience

To describe the performance and clinical outcomes of consecutive patients having a leadless pacemaker (LP) implanted at a single institution.

Clinical data and device parameters were prospectively collected on all patients undergoing LP implantation from November 2015 to April 2018.

A total of 79 patients (52 male), median age of 78 years, was included. Leadless pacemaker implantation was successful in 76 patients (96%). Implantation failed in two patients due to excessive venous tortuosity and due to inadequate sensing in another. Seventy-three (73) patients (96%) had chronic atrial fibrillation and all had a Class I or II indication for pacing. Procedure time was 29minutes (IQR 21-43) and fluoroscopy time was 8minutes (IQR 5-13). The median R wave at implant was 11.2mV (IQR 6.9-15.0). The median capture threshold at 0.24ms was 0.5V (IQR 0.4-0.9) and impedance was 754Ω (IQR 680-880). Intraprocedural acute dislodgement occurred in one patient following cutting of the tether but successful snaring and reimplantation was performed. During a median follow-up of 355days (range 9-905), overall electrical performance has been excellent. No patients have been readmitted for device revision or complications. Five (5) patients (7%) died during follow-up from unrelated causes.

Leadless pacemakers can be implanted safely and effectively in the majority of patients. Device electrical performance was excellent over a median follow-up of 12 months.