Leadless pacemakers in patients with active haematological cancer: procedural details and long-term clinical outcomes
M Farkowski, I Zastawna, R Supryn, P Rusztyn, B Lech, K Gajos, I Hus, R GilAbstract
Background/Introduction
leadless pacemakers (LPR) are primarily indicated for patients with bradyarrhythmia and high risk of infection from transvenous pacemaker.(1) Patients with haematological malignancies may be at a risk of device-related infection due to underlying disease and treatment; however available evidence is limited to case-studies.(2,3) What is more, the risk of complication of arrhythmia ablation, another catheter-based technology for arrhythmia treatment, is elevated in this population.(4)
Purpose
to describe the outcomes of LPM implantation in patients undergoing active treatment for haematological malignancies.
Methods
eligible patients underwent LPM implantation for standard bradyarrhythmia indications during periods of active haematological cancer treatment. Data on demographics, indications, haematological diagnoses, procedural outcomes, and long-term follow-up were retrospectively collected from the medical records of a tertiary general hospital with both cardiology and haematology departments.
Results
Between 2023 and 2025, seven of 57 (12%) patients who received an LPM were undergoing active treatment for haematological malignancy. All cases were evaluated by a dedicated Electrophysiological Haemato-Onco Heart Team (EP HOT) composed of cardio-oncologist, haematologist and/or oncologist and invasive electrophysiologist. Baseline characteristics of the study group: mean age 83±6 years, 100% male, atrial fibrillation and advanced atrio-ventricular block present in 6 (86%) patients. Haematological diagnosis comprised: myelodysplastic syndrome (2 patients), T-cell large granular lymphocyte leukaemia (T-LGL), chronic lymphocytic leukaemia (CLL), primary large B-cell lymphoma of immune-privileged sites (IP-LBCL), diffuse large B-cell lymphoma not otherwise specified (DLBCL, NOS), mycosis fungoides (MF). Ultrasound-guided femoral vein access was used in all patients. LPM was positioned in the right ventricle under fluoroscopy, using ventricular angiogram and paced QRS morphology mapping. The mean final pacing impedance was 720±140 Ohm. There were no procedural complications. During a mean follow-up of 232±159, five (72%) patients continued the same haematological treatment, one (14%) experienced disease progression requiring treatment modification and one (14%) died due to disease progression. There were no long-term complications of the LPM therapy or upgrades to dual-chamber pacing.
Conclusions
leadless pacemakers appear to be a feasible and safe option for patients with active haematological malignancies. However, larger multicentre studies are needed to confirm these findings.