Abstract 14011: Micra AV Leadless vs. Dual-Chamber Transvenous Pacing Outcomes Among Patients With End-Stage Renal Disease in the Medicare Population

Abstract

Introduction: Leadless pacing is often considered a useful alternative for patients with end-stage renal disease (ESRD) due to their limited vascular access and high infection risk. However, there is limited evidence on the comparative outcomes of leadless pacing vs. transvenous pacing in this population. Hypothesis: The reduction in complications and reinterventions associated with leadless pacing in the broader population extends to patients with ESRD. Aims: To compare complications and reinterventions between ESRD patients implanted with a Micra AV leadless pacemaker vs. a dual-chamber transvenous pacemaker. Methods: Data from the Micra Coverage with Evidence Development (CED) Study were used to identify ESRD patients implanted with a Micra AV leadless pacemaker (N=1,116), or a dual-chamber transvenous pacemaker (N=2,163) between February 5, 2020 and December 1, 2021 in the Medicare population. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day acute complication rates. Cox models were used to compare 6-month chronic complications and reinterventions between groups. Results: ESRD patients implanted with Micra AV had a higher overall comorbidity burden (mean Charlson Comorbidity Index 7.9 vs. 7.6, P=0.001) and higher rates of emergency admission (18.6% vs. 14.0%, P=0.001). Despite these differences, there was no difference in the rate of complications at 30 days (unadj. 13.9% vs. 13.8%, P=0.92; adj. 12.9% vs. 14.6%, P=0.20). At 6 months, Micra AV patients had significantly lower rates of chronic complications (unadj. HR 0.72, 95% CI: 0.54-0.96, P=0.02; adj. HR 0.64, 95% CI: 0.48-0.87, P=0.004) and reinterventions (unadj. HR 0.50, 95% CI: 0.29-0.86, P=0.01; adj. HR 0.53, 95% CI: 0.30-0.91, P=0.02) (figure) . Conclusion: In patients with ESRD, AV synchronous leadless pacing is associated with lower rates of complications and need for reintervention compared to dual-chamber transvenous pacing.