Abstract 14799: Temporal Trends and In-Hospital Outcomes of Patients Undergoing Leadless Pacemaker Placement: Highlights From National Inpatient Sample 2016-2020

Abstract

Introduction: Leadless pacemakers (LPM) were introduced to address rates of pocket and lead-related complications associated with transvenous pacemakers (TPM) and to improve clinical outcomes in those who may be at high risk for TPM placement. Limited data exists on in-hospital outcomes and temporal trends of LPM placement. Methods: National Inpatient Sample 2016-2020 was used to query pacemaker (PM) placements and these were grouped into LPM and TPM cases using appropriate ICD procedure codes. Logistic regression was used to compare baseline characteristics and in-hospital outcomes. Results: 740,240 PM placements were observed between 2016 and 2020, with 3.9% (29,015) LPM cases and 96.1% (711,225) TPM cases. As shown in Table 1, there was an increasing temporal trend in LPM placement from 2016 with an overall stable trend in TPM during the same time. The LPM group had a higher proportion of cases that underwent extraction of an old pacemaker (8.9% -vs- 6.9%, p=0.004). A majority of procedures in both groups were performed in the Southern United States and predominantly in large bedsize, urban teaching hospital systems. As shown in Table 2, LPM group had higher proportions of atrial fibrillation, CKD (stage 3 or greater), and ESRD. Length of stay (LOS, 9.7 -vs- 5.9 days) and overall mortality (5.0% -vs- 1.5%, p=0.001) were also higher in the LPM group. Conclusions: There has been a significant increase in LPM placement from 2016 through 2020 as seen with an increasing temporal trend. Use of LPM in medically complex cases or in cases that are high risk for TPM placement continues to increase. Further research needs to be performed to analyze long-term outcomes in this group.