Leadless vs. transvenous pacemaker strategy following transcatheter aortic valve replacement: a systematic review and meta-analysis
G Dagostin De Carvalho, R Fonseca Oliveira Suruagy Motta, C Felizardo Souza Catao Nogueira, E Damiani Bertoli, G Lima Vieira Barbosa, E Lima Ornelas Pinto, L Dexheimer Da Silva, B Noschang Blaas, S Rodrigo De Ramalho Moraes, A Aurelio Marinho Rosa Filho, G W StoneAbstract
Background
Conduction disturbances and arrhythmias remain common after transcatheter aortic valve replacement (TAVR), frequently requiring permanent pacemaker implantation in an elderly, high-risk population. Leadless pacemakers (LPMs) eliminate pocket and lead-related complications and have demonstrated noninferior safety in non-TAVR cohorts. However, comparative evidence between LPM and transvenous pacemakers (TVP) specifically after TAVR remains limited.
Methods
A systematic search of PubMed, Cochrane Library, Embase, Web of Science and Scopus was conducted to identify studies comparing LPM versus TVP in patients undergoing TAVR. Random-effects models were used to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, device-related complications, rehospitalization, and vascular access complications. Heterogeneity was assessed using I² statistics. Analyses were performed with R (version 4.2.3).
Results
Five retrospective studies involving 10,494 patients were analyzed, of which 794 (7.6%) underwent LPM implantation. When compared to TVP, LPM implantation was associated with a significantly lower incidence of device-related complications (RR 0.31; 95% CI 0.14–0.69; p<0.004) and vascular access complications (RR 0.15; 95% CI 0.03–0.68; p=0.01). However, there was no significant difference in rehospitalization rates (RR 1.37; 95% CI 0.22–8.37; p=0.73). LPM use, on the other hand, was linked to an increased risk of all-cause mortality (RR 1.61; 95% CI 1.01–2.57; p=0.04).
Conclusions
In patients requiring permanent pacing after TAVR, LPMs were associated with fewer device-related and vascular access complications compared with TVPs, but with a higher risk of all-cause mortality. Rehospitalization rates did not differ significantly between strategies. Further prospective studies are warranted to clarify optimal pacemaker selection in this population.