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Leadless Pacemaker in Bradyarrhythmia After Transcatheter Aortic Valve Replacement: A Meta-Analysis
Patavee Pajareya1, Watsapon Chuanchai1, Khamik Laohasurayotin1
1From the Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Leadless pacemakers (LPM) show a significantly lower complication rate for bradyarrhythmia after transcatheter aortic valve replacement (TAVR) compared to transvenous pacemakers (TPM). LPM offers a safer alternative with comparable efficacy and feasibility.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Interventional Cardiology
Background:
- Transvenous pacemakers (TPM) carry infection risks, particularly in patients needing bradyarrhythmia management post-transcatheter aortic valve replacement (TAVR).
- The safety and efficacy of leadless pacemakers (LPM) in the post-TAVR bradyarrhythmia population remain largely unexamined.
Purpose of the Study:
- To systematically evaluate the safety and feasibility of leadless pacemakers (LPM) versus transvenous pacemakers (TPM) for bradyarrhythmia management following transcatheter aortic valve replacement (TAVR).
- To compare complication rates, mortality, heart failure hospitalizations, and procedural metrics between LPM and TPM in this patient cohort.
Main Methods:
- A systematic literature search was conducted from inception to November 2025, including studies of adult patients receiving pacemakers after TAVR.
- Primary endpoints included overall and device-related complications; secondary endpoints encompassed mortality, heart failure hospitalizations, procedure time, fluoroscopy time, and length of stay.
- Meta-analysis was performed on data from 11 studies involving 11,750 patients (1243 LPM, 10,507 TPM).
Main Results:
- The leadless pacemaker (LPM) group demonstrated significantly lower device-related complication rates (aHR 0.35) and no device-related mortality compared to the transvenous pacemaker (TPM) group.
- All-cause mortality and heart failure hospitalization rates were comparable between LPM and TPM groups.
- Procedural feasibility, including procedure time, fluoroscopy time, and length of stay, was similar between LPM and TPM.
Conclusions:
- Leadless pacemakers (LPM) represent a safer first-line pacing strategy for bradyarrhythmia post-transcatheter aortic valve replacement (TAVR).
- LPM offers comparable efficacy and feasibility to traditional transvenous pacemakers (TPM) with a reduced risk of device-related complications.
