Long-Term Outcomes of Leadless Pacemaker vs. Transvenous Pacemaker in End-Stage Renal Disease

Patients with end-stage renal disease (ESRD) undergoing dialysis have an increased risk of pacemaker-related complications due to limited vascular access and increased susceptibility to infection. Leadless pacemakers (LPMs) may mitigate these risks compared with conventional transvenous pacemakers (TPMs), but long-term comparative data in this population remain limited.

We conducted a retrospective cohort study using the TriNetX Research Network, including adults (≥ 18 years) with ESRD on dialysis who underwent LPM or TPM implantation between May 2016 and December 2020. Propensity score matching (1:1) was performed using demographics and comorbidities. Outcomes assessed over up to 5 years included all-cause hospitalization, heart failure hospitalization, device re-intervention, device-related complications, infection-related hospitalization, pacemaker-induced cardiomyopathy, and all-cause mortality.

After matching, 901 patients were included in each group with well-balanced baseline characteristics. LPM implantation was associated with a significantly lower risk of device re-intervention compared with TPM (4.1% vs. 9.3%; hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.28-0.69; p < 0.01). There were no significant differences between groups in all-cause hospitalization (65.5% vs. 68.3%; p = 0.22), heart failure hospitalization (26.9% vs. 30.2%; p = 0.13), all-cause mortality (37.5% vs. 35.3%; p = 0.34), device-related complications (14.5% vs. 14.3%; p = 0.94), infection-related hospitalization (1.6% vs. 2.1%; p = 0.35), or pacemaker-induced cardiomyopathy (9.0% vs. 8.6%; p = 0.66).

In a large, propensity-matched cohort of patients with ESRD on dialysis, LPMs were associated with fewer device re-interventions and comparable long-term clinical outcomes compared with TPMs.