Abstract 16848: Reduced Survival of Patients Treated With Leadless Right Ventricular Pacemakers

Introduction: Leadless right ventricular pacemakers (LVP) are particularly valuable for patients who lack venous access for transvenous pacing (TVP) or who are at risk for pocket complications including infection, erosion, or hematoma. Since such patients constitute a unique population, we sought to compare their 2-year survival (SURV) to that of patients paced with traditional TVP or conduction system pacemakers (CSP).

Hypothesis: The SURV of patients treated with a LVP for reasons related to venous access or potential pocket complications is different from the SURV of TVP or CSP patients.

Methods: We calculated the weighted and unweighted Kaplan-Meier SURV of patients implanted with a LVP, TVP, or CSP at our institution. The Piccini risk score variables (age, BMI, gender, heart failure, CAD, prior MI, pulmonary hypertension, COPD, atrial fibrillation, prior cardiac intervention, and chronic kidney disease) were used to weight patients via the generalized linear model method, which successfully reduced comorbidity variability between the LVP, TVP, and CSP groups. All analyses were conducted in R 4.2.3.

Results: The weighted and unweighted SURV of 335 patients who were implanted with a LVP (n=196), CSP (n=89), or traditional TVP (n=50) are shown in the graph. Despite weighting patients using the Piccini risk score, LVP SURV was significantly lower than that of patients paced with TVP or CSP pacemakers (p<0.01). The SURV of CSP and TVP patients were similar (p=0.51).

Conclusions: For unclear reasons, the near-term prognosis of these LVP patients appears to be considerably less favorable than those receiving TVP or CSP pacemakers. Importantly, while further study is needed, this finding should be considered when evaluating the survival of leadless pacemaker populations.