Leadless or Conventional Transvenous Ventricular Permanent Pacemakers: A Nationwide Matched Control Study

Area of Science:

• Cardiology
• Medical Devices
• Clinical Outcomes Research

Background:

• Lead-related complications are a concern with conventional pacemakers.
• Leadless VVI pacemakers (LPM) were developed to mitigate these risks.
• Real-world comparisons of LPM and conventional VVI pacemakers (CPM) are essential.

Purpose of the Study:

• To compare clinical outcomes of LPM versus CPM.
• To evaluate outcomes within 30 days and during midterm follow-up.
• To assess all-cause death, cardiovascular death, and endocarditis rates.

Main Methods:

• Longitudinal cohort study using French national hospitalization data.
• Inclusion of adult patients receiving their first LPM or CPM (Jan 2017-Sep 2020).
• Propensity score matching used to compare similar patient groups (1344 pairs).

Main Results:

• LPM patients had lower 30-day all-cause and cardiovascular death rates.
• In unmatched populations, midterm all-cause death risk was higher with LPM.
• After matching, no significant differences in midterm all-cause death, cardiovascular death, or endocarditis between LPM and CPM.

Conclusions:

• Leadless VVI pacemakers demonstrate superior early clinical outcomes compared to conventional VVI pacing.
• Midterm follow-up reveals comparable risks for all-cause death, cardiovascular death, and endocarditis after propensity score matching.
• LPM offers potential advantages in the early post-implantation period without significant midterm disadvantages.