Abstract 15363: Safety of Leadless Pacemakers vs. Transvenous Pacemakers in Patients Older Than 65 Years

Abstract

Introduction: Leadless pacemakers (LP) are a less invasive option compared to conventional transvenous pacemakers (TVP). They were introduced with the hope of eliminating complications associated with TVP and leads, which are more common among the elderly population. However, evidence supporting their use is uncertain. This study aims to compare the safety of the LP compared to TVP in patients 65 and older. Methods: We retrospectively analyzed consecutive patients, aged 65 and older, who were implanted a LP or TVP between August 2017 and November 2021, in 2 experienced Cardiovascular centers. The primary endpoint was a composite of any procedure-related complication (hematoma, venous thrombosis, infections, hemothorax, device dislodgement, pneumothorax). The secondary endpoint was the need for reinterventions. Results: A total of 313 patients were included; 219 received a TVP and 94 patients received a LP. Of the TVPs implanted, 68% used cephalic access, 21% axillary and 11% subclavian. The mean age was 78.9 + 7.76 for the TVP group and 82.6 +8.83 for the LP group. A total of 23 patients in the TVP group reached the primary end point vs 4 patients in the LP group, with a relative risk reduction of 60% of procedure related complications in LP compared to TVP (risk ratio [RR]:0.4; 95% CI (0.144-1.139); P= 0.043). In addition, 8 patients in the TVP group reached the secondary outcome vs none in the LP group (3.65% vs. 0%; p= <0.00001).. There were no statistically significant differences in individual outcomes between the TVP group and the LP group: incision-site hematomas (11 (5%) vs. 2 (2.1%); p=0.24), venous thrombosis (2 (2%) vs 1 (0.5 %); p=0.9), infections (1 (0.5%) vs 1 (1%) ; p=0.54), hemothorax (1 (0.5%) vs. 0 (0%); p=1), device dislodgement (8 (3.6%) vs 0 (0%); p=0.11), pneumothorax (none in either group). Conclusion: This study demonstrates that LP is a safer option than TVP among patients aged 65 and older. Additional studies are needed to further establish these findings. 1