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Impact of comorbidity on complication rates and life expectancy in patients with a leadless pacemaker

Tardu Özkartal1, Alessia D'Alto2, Marco Bergonti1

  • 1Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.

International Journal of Cardiology
|August 16, 2024
PubMed

Insights

Leadless pacemaker implantation is safe in elderly patients, even with high comorbidity. Mortality rates for patients with low comorbidity (CCI ≤ 3) were similar to the general population.

Area of Science:

  • Cardiology
  • Medical Devices
  • Geriatrics

Background:

  • Limited data exists on the outcomes of leadless pacemakers (LPM) concerning patient age and comorbidities.
  • Understanding these factors is crucial for optimizing patient selection and management.

Purpose of the Study:

  • To investigate the outcomes of LPM implantation in relation to patient age and comorbidity status.
  • To compare complication rates and mortality between patients with low and high comorbidity levels.

Main Methods:

  • A multi-center, retrospective analysis of 863 patients who received LPMs between 2015 and 2022 in Switzerland.
  • Patients were stratified by Charlson Comorbidity Index (CCI) into low (≤5) and high (>5) comorbidity groups.
  • Outcomes assessed included peri-procedural complications, in-hospital death, and all-cause mortality, with comparisons to the general Swiss population for specific CCI groups.

Main Results:

  • No significant difference in peri-procedural or long-term complication rates between low and high comorbidity groups.
  • In-hospital mortality was higher in the high-comorbidity group (3.6% vs. 0.6%).
  • All-cause mortality was significantly higher in the high-comorbidity group (HR 2.9), with a three-year mortality of 58% compared to 22% in the low-comorbidity group.

Conclusions:

  • Leadless pacemaker implantation is a safe procedure in elderly patients, irrespective of high comorbidity, with no increased risk of complications.
  • All-cause mortality in LPM patients with a low comorbidity index (CCI ≤ 3) is comparable to the general Swiss population.
  • Despite competing risks, LPMs offer a safe pacing solution for elderly individuals with significant comorbidities.
Abstract

Keywords:
Charlson comorbidity indexComplicationLeadless pacemakerMicraTranscatheter pacemaker

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