Safety of Leadless Pacemaker Insertion in Nonagenarians
Jashan Gill1, Ahmad Harb2, Jobin Varghese1
1Department of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA.
Summary
Leadless pacemaker insertion appears safe for patients aged 90 and older, showing lower mortality and fewer complications than younger patients. However, potential survivorship bias warrants consideration in the very elderly undergoing this procedure.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Advanced age is linked to frailty and poorer surgical outcomes.
- Leadless pacemakers (LPMs) offer a less invasive alternative for cardiac rhythm management.
Purpose of the Study:
- To evaluate the safety and outcomes of leadless pacemaker insertion in nonagenarians (patients aged ≥90 years).
Main Methods:
- Analysis of the National Readmission Database (2017-2020) comparing patients ≥90 years with those <90 years undergoing LPM insertion.
- Multivariate regression analysis adjusted for patient comorbidities.
Main Results:
- Nonagenarians had a shorter length of stay, lower mortality, and reduced rates of cardiac arrest, mechanical ventilation, and vasopressor use.
- Increased risk of pericardial complications was observed in nonagenarians.
- No significant differences in 30-day readmissions, postoperative bleeding, or stroke rates.
Conclusions:
- Leadless pacemaker insertion is a potentially safe procedure for the very elderly population.
- Survivorship bias and unmeasured confounders may influence outcomes in nonagenarians.
- Chronological age alone may not be a significant risk factor for adverse outcomes in this cohort.
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