Clinical outcomes and predictors of complications in patients undergoing leadless pacemaker implantation

Pacing‐induced cardiomyopathy after leadless pacemaker implant: It's all about location, location, location

“…In summary, the importance of LP as a pacing modality is likely to grow as patient populations requiring pacing support shift toward older age and greater comorbidity 8 . In this context, the findings reported here by Shantha et al provide important evidence to guide expectations regarding LP and future PICM risk, to aid what is an increasingly complex decision regarding choice of pacing strategy.…”

“…Early work suggested that an apical transvenous RV lead position may be associated with greater PICM risk versus a septal lead position, 5 although this finding was subsequently refuted by multiple studies 2,6,7 . Recently, leadless pacemakers (LP) have emerged as an alternative to transvenous devices, offering lower complication rates for patients who do not require atrial pacing, such as those with long‐standing persistent atrial fibrillation (AF) 8 . Limited data exist regarding risk of PICM after LP, although one small study suggests PICM incidence may be lower 9 .…”

“…Since the technique is relatively new, risk of PICM following left bundle branch area pacing remains unclear, although physiologic rationale and early data on resynchronization suggest PICM risk should be very low 12 . In this context, the finding that PICM risk may be reduced to <5% at roughly 1.5 years using HS placement is important, particularly given prior evidence supporting lower complication rates with LP compared to transvenous systems 8 . For now, the choice of pacing system is still best made on a case‐by‐case basis considering multiple patient factors, but the observations by Shantha et al may lower the threshold for choosing LP if a lower risk of PICM can be expected when the device is placed in a septal position.…”

“…2,6,7 Recently, leadless pacemakers (LP) have emerged as an alternative to transvenous devices, offering lower complication rates for patients who do not require atrial pacing, such as those with longstanding persistent atrial fibrillation (AF). 8 Limited data exist regarding risk of PICM after LP, although one small study suggests PICM incidence may be lower. 9 Furthermore, it is unclear whether anatomic location of LP implant may affect PICM incidence.…”

Leadless Pacing: Therapy, Challenges and Novelties

“…In the most extensive cohort study to date involving 7,821 patients, the rate of effusion requiring intervention was 1%. 14 It is unclear whether this is likely to decrease further with time. The elimination of pocket-and lead-related problems, however, means that it is likely that leadless pacing will outperform conventional pacing in terms of all-cause complications in the long term.…”