Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker

Abstract

Abstract Background Leadless pacemaker has a low risk of complications such as infection, pneumothorax, and skin erosion, and it is good adaptation for elderly patients. While ventricular pacing induces ventricular desynchronization, and that is causes of heart failure. The aim of the present study, therefore, was to investigate the association between heart failure hospitalization and leadless pacemaker implantation. Methods Between September 2017 and January 2022, 929 consecutive patients were implanted pacemakers. The patients were divided according to types of pacemakers: leadless pacemaker (LPM group, n=368), and conventional pacemaker (PM group, n=561). The clinical outcome was heart failure hospitalization. Hospitalization was considered when patients presented with sign and symptoms consistent with heart failure and required intravenous therapy, and the indication of heart failure hospitalization was at the discretion of the physician. Follow-up visit was planned at 1, 3, 12, 24, and 36 months after pacemaker implantation. Clinical follow-up data were obtained from medical records and/or by telephone contact with the patients, families, or referring physicians. Results The median follow-up duration was 1.7 years (interquartile range 0.8-2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3% at 1 year, 15.6% at 2 years, and 21.6% at 3 years, respectively. Adjusted heart failure hospitalization risk in the LPM group was significantly higher than the risk in the PM group (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.09-2.64, P=0.01). Patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group (n=150) were more admitted to the hospital for heart failure, compared with in the PM group (n=219) (HR 2.02, 95%CI 1.04-3.90, P=0.03), while no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group, n=71; PM group, n=18) or atrioventricular block (LPM group, n=147; PM group, n=324). Conclusions Hospitalization risk for heart failure was higher in patients with leadless pacemakers, compared with conventional pacemakers. The greater risk was mainly driven by older patients and patients with SND.