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Pacing-Induced Cardiomyopathy in Leadless and Transvenous Pacemakers: A Meta-Analysis and Meta-Regression
Frengki Prabowo Saputro Wijayanto1, Artha Maressa Theodora Simanjuntak1, Christopher Daniel Tristan2
1Department of Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Pacing and Clinical Electrophysiology : PACE
|May 22, 2026
Summary
Leadless pacemakers show a similar risk of pacing-induced cardiomyopathy (PICM) compared to transvenous systems. This study found leadless pacing has a non-inferior PICM risk and a lower rate of cardiac resynchronization therapy upgrade.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Leadless pacemakers offer an alternative to transvenous systems, aiming to reduce complications.
- The impact of leadless pacing on pacing-induced cardiomyopathy (PICM) requires further investigation.
Purpose of the Study:
- Evaluate the prevalence of PICM in patients receiving leadless pacemakers.
- Compare the risk of PICM between leadless and transvenous pacing systems.
- Assess the rate of cardiac resynchronization therapy (CRT) upgrade in leadless pacing.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, Scopus, and ScienceDirect databases up to January 2026.
- Included studies reporting PICM with leadless pacing or comparing leadless and transvenous systems; used random-effects models for pooled prevalence and risk ratios.
Main Results:
- Pooled PICM prevalence in leadless pacing was 13% (95%CI: 4%-23%).
- PICM risk was similar between leadless and transvenous pacing (RR 1.00; 95%CI: 0.77-1.29).
- Leadless pacing showed a lower CRT upgrade rate (RR 0.56; 95%CI: 0.48-0.66); baseline heart failure predicted PICM.
Conclusions:
- Leadless pacemakers present a non-inferior risk of PICM compared to transvenous systems.
- Leadless pacing demonstrates similar safety profiles and a reduced rate of CRT upgrade.
- Standardized PICM definitions and improved reporting are crucial for future research.
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