Precision patient selection for ablate-and-pace: a multi-center study comparing leadless pacemaker vs. standard...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Atrioventricular node (AVN) ablation with ventricular pacing (
• ablate-and-pace") is effective for rate control in permanent atrial fibrillation (AF).
• Conventional transvenous pacemakers carry risks of lead- and pocket-related complications.
• Leadless pacemakers are a potential alternative, but comparative data are limited.

Purpose of the Study:

• To compare the clinical outcomes of leadless vs. transvenous single-chamber pacemakers in patients undergoing AVN ablation for permanent AF.
• To evaluate the safety and efficacy of leadless pacemakers in the
• ablate-and-pace" setting.

Main Methods:

• Retrospective, multicenter study (LEAD-AP) of 168 patients undergoing
• ablate-and-pace" between 2017-2024.
• Patients received either a leadless pacemaker (n=56) or a transvenous VVI pacemaker (n=112).
• Primary efficacy endpoint: composite of mortality, AF-related hospitalizations, and device-related events. Primary safety endpoint: acute complications within 30 days.

Main Results:

• The leadless group had a higher rate of single-step
• ablate-and-pace" (96.4% vs. 10.9%, p<0.001) and shorter hospitalization (1.1 vs. 5.7 days, p=0.008).
• At 24 months, no significant difference in event-free survival for the primary efficacy endpoint between leadless and transvenous groups (82.1% vs. 80.4%, p=0.29).

Conclusions:

• Leadless pacemakers demonstrate comparable safety and efficacy to transvenous systems in
• ablate-and-pace" patients.
• Leadless systems facilitate a streamlined single-step approach, leading to shorter hospitalizations.