Leadless pacemaker vs conventional single chamber pacemaker for urgent permanent implantation in elderly and very elderly patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Data on feasibility of leadless pacemaker (LPM) in the elderly and very elderly is scarce. We aimed to investigate the security and feasibility of urgent LPM implantation in elderly patients. Methods Observational study of a prospective register of consecutive patients that underwent LPM insertion in a single centre. Elderly (≥75 years) and very elderly patients (≥85 years) that underwent LPM implantation in a non-elective setting between June 2016 and January 2020 were eligible. We compared pacing thresholds, R wave and impedance at baseline, short- and long term follow-up. Furthermore, we compared complication rate and all-cause mortality of LPM patients to patients that underwent conventional SCP insertion. Results 78 elderly patients (25 LPM, 53 SCP) with a mean age of 82.4 and 83.8 years, respectively (p = 0.82), were included in the study. The mean follow-up time was 11.2 months. 35 patients (11 LPM, 24 SCP) had an age of ≥ 85 years. There were no significant differences with respect to demographic and baseline clinical data between LPM patients and SCP patients. (Table) Furthermore, we did not find significant changes in pacing thresholds, R wave and impedance on short- and long-term follow-up. Complication rates at 12 months of elderly and very elderly LPM patients were similar to those that underwent conventional SCP implantation (0% vs 5.7%, p = 0.35; 0% vs 4.2%, p = 0.41, respectively). Likewise, we did not find significant differences regarding all-cause mortality (12% vs 13%, p = 0.92; 9% vs 25%, p = 0.18). Comparing Kaplan-Meier curves, no significant differences were found regarding 12 month complication rate and all-cause mortality between LPM patients and conventional SCP patients, as assessed by Log Rank test (p = 0.98 and p = 0.91, respectively). (Figure) Conclusion LPM implantation is a feasible and secure alternative to conventional SCP insertion in elderly and very elderly patients, even in a non-elective setting. Basline characteristicsBaseline characteristicsConventional SCP, n = 53Leadless pacemaker, n = 25p-valueAge - years83.8 (±6.4)82.4 (±6.4)N/SSex, male - n (%)28 (52)16 (64)N/SChronic kidney disease - n (%)16 (30)6 (24)N/SAtrial fibrillation - n (%)45 (85)19 (76)N/SCharlson index, (IQR)4 (3-7)5 (4-7)N/SR wave amplitude, mV (IQR)10.5 (7.4-13.3)12.2 (9.3-15.2)N/SPacing threshold, mV (IQR)0.6 (0.5-0.9)0.4 (0.3-0.7)N/SImpedance, Ohm (IQR)669 (±185)713 (±191)N/SIQR, interquartile range; N/S: Not significant; SCP: Single chamber pacemaker​Abstract Figure. Kaplan Meier curves, Mortality