Trends and In-Hospital Outcomes of Conventional Transvenous Pacemaker vs. Leadless Pacemaker　- Nationwide Matched...

Area of Science:

• Cardiology
• Medical Devices
• Health Outcomes Research

Background:

• Limited nationwide data exists on in-hospital outcomes comparing leadless pacemakers (LPMs) and transvenous pacemakers (TVPMs) in Japan.
• Transvenous pacemaker implantation is the traditional method, while LPMs offer a less invasive alternative.

Purpose of the Study:

• To compare in-hospital deaths and complications between LPMs and TVPMs using a Japanese nationwide database.
• To analyze trends in LPM adoption and identify patient characteristics associated with their selection.

Main Methods:

• Analysis of a nationwide database of adult pacemaker implantations between 2017 and 2023.
• Propensity score matching was used to create comparable groups of LPM and TVPM recipients (12,599 per group).
• Outcomes assessed included in-hospital death, all complications, cardiac tamponade, and 7-day all-cause mortality.

Main Results:

• LPM implantation increased significantly from 0.5% to 25% during the study period.
• Composite outcomes (death and complications) were similar between LPM and TVPM groups (5.41% vs. 5.59%, P=0.44).
• Higher rates of cardiac tamponade (0.29% vs. 0.06%, P<0.001) and 7-day all-cause death (0.58% vs. 0.33%, P=0.003) were observed in the LPM group.

Conclusions:

• While overall outcomes are comparable, leadless pacemakers are associated with increased risks of cardiac tamponade and early death.
• Physicians should consider these specific risks when selecting pacemakers for patients.
• Further research may be needed to understand and mitigate these LPM-associated complications.