Abstract
The leadless cardiac pacemaker (LCP) is typically implanted percutaneously, but can also be implanted under direct visualization during valve surgery in patients with either a pre-existing pacing indication or who are at high risk for post-op bradyarrhythmias. To compare the impact of timing of LCP implantation on the length of hospitalization in patients undergoing intra-operative (during valve surgery) vs post-operative (prior to discharge) leadless pacemaker implantation. We conducted a retrospective review of patients undergoing valve surgery between 8/1/2018 and 11/30/2020, and received an LCP (Micra, Medtronic Inc) either intra-operatively (n=27) or post-operatively (n=23) during the index hospitalization. The STS short-term risk scores for mortality and/or morbidity were similar between the intra-operative and post-operative groups (1.6 vs 2.3%, p = 0.646; 14.6 vs 12.7%, p = 0.437, respectively). Patients receiving an intra-operative LCP spent significantly fewer median days in the ICU (3 vs 5 days, p = 0.03) and had a significantly shorter median total length of stay (11 vs 16 days, p = 0.036). Despite similar pre-operative co-morbidities, intra-operative implantation of an LCP in select patients at high risk for post-operative bradyarrhythmias is associated with a significantly shorter lengths of stay in both the ICU and the hospital. Future studies should identify which patients may benefit most from this prophylactic approach to pacing in at-risk patients undergoing valve surgery.
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