[Feasibility and safety of leadless pacemaker implantation in elderly patients]

Objectives: To analyze the feasibility and safety of leadless pacemakers in elderly patients. Methods: This retrospective cohort study analyzed 140 patients who underwent leadless pacemaker implantation at People's Hospital of Peking University and People's Hospital of Henan Province between January 2020 and December 2023. The patients were categorized into a non-elderly group (age<75 years) and an elderly group (age≥75 years). The study compared and analyzed demographic information, clinical data, pacing parameters during the surgery and surgery-related complications between the two groups. Pacing parameters (threshold, sensing, and impedance) were monitored in both groups at 24 hours, 3 months, and 6 months post-procedure, and pacing-related complications were recorded. Results: A total of 140 patients were enrolled, with a mean age of (73.6±13.2) years, including 83 males (59.3%). There were 64 patients in the non-elderly group and 76 patients in the elderly group. Compared to the non-elderly group, the elderly group had a lower body mass index, a higher proportion of comorbidities such as atrial fibrillation/atrial flutter, hypertension, coronary heart disease, and stroke, and a lower proportion of postoperative valvular diseases (all P<0.05). The elderly group had a higher proportion of patients undergoing leadless pacemaker implantation for the first time (48.7% (37/76) vs. 21.9% (14/64), P=0.001) and a lower rate of leadless pacemaker re-implantation after infection and lead removal (43.4% (33/76) vs. 65.6% (42/64), P=0.006) than the non-elderly group. There were no significant differences in pacing parameters at the time of leadless pacemaker implantation between the two groups (all P>0.05). All patients were successfully implanted with a leadless pacemaker, with only 1 case (0.7%) in the elderly group experiencing pericardial tamponade, which was resolved through puncture and drainage. Additionally, no notable disparities in pacing threshold, sensing, and impedance were observed during the 24-hour, 3-month, and 6-month follow-up periods between the two groups (all P>0.05), and no pacemaker-related complications were observed. Conclusion: Implantation of a leadless pacemaker device in elderly patients (age≥75 years) is safe and effective.