ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Comparison of readmission outcomes and complications between leadless and traditional transvenous pacemakers in older adults: a nationwide readmission analysis of 49852 admission events.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsWhile transvenous pacemakers (TV-VVI) are standard for bradyarrhythmia, lead- and pocket-related complications remain concerns. Leadless pacemakers (LPMs) may reduce these risks. However, direct comparisons between LPMs and single-chamber TV pacemakers are limited. This study aimed to compare clinically meaningful outcomes between LPM and TV-VVI using real-world data. METHODS AND
resultsUsing the National Readmissions Database (NRD), we analysed demographics, readmission rates, and 30-day outcomes of patients aged ≥65 years who underwent LPM or TV-VVI implantation between 2016 and 2022. Admissions were identified via ICD-10 codes. Outcomes were assessed in the propensity score-matched population (10 594 patients per group) through multivariable logistic regression after 1:1 high-dimensional propensity score matching (caliper 0.1 SD) to adjust for confounding. Among 49 852 patients, 44.8% received LPM. Median age was 84 vs. 81 years in TV-VVI and LPM groups; 46.2% were female. TV-VVI patients had significantly higher rates of device-related complications [adjusted OR (aOR): 0.45, 95% CI (0.30-0.65), P < 0.001], device revision or replacement [aOR: 0.20, 95% CI (0.11-0.36), P < 0.001], implant-related complications [aOR: 0.58, 95% CI (0.34-0.97), P = 0.040]. Crude rates of arteriovenous fistula, pseudoaneurysm, and pericardial complications were higher in LPM, but adjusted differences were non-significant. Thirty-day readmission rates were similar between LPM and TV-VVI groups at 15.5% and 15.9%, respectively. Mortality and prolonged length of hospital stay also showed no significant differences.
conclusionNationally representative data indicate that LPM implantation is associated with fewer device-related complications compared to TV-VVI, though further studies are needed to evaluate long-term outcomes.
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