Key result
Leadless pacemakers are linked to similar 24-month event-free survival versus transvenous pacemakers.
Why the study?
Conventional transvenous pacemakers carry lead- and pocket-related complications, and comparative data assessing leadless pacemakers in patients undergoing AVN ablation for permanent AF remain scarce.
Does a leadless pacemaker improve clinical outcomes compared to a conventional transvenous VVI pacemaker in patients undergoing ablate-and-pace for permanent atrial fibrillation?
Cohort (n=168)
Yes
Does a leadless pacemaker improve clinical outcomes compared to a conventional transvenous VVI pacemaker in patients undergoing ablate-and-pace for permanent atrial fibrillation?
Leadless pacemakers provide comparable safety and efficacy to transvenous systems in ablate-and-pace patients, while enabling shorter hospitalization through a streamlined single-step approach.
Shorter hospitalizations with leadless pacemakers merit prospective confirmation; leaves open long-term outcome equivalence versus transvenous systems in permanent AF.
Background and aims In patients with symptomatic permanent atrial fibrillation (AF) who are not candidates for rhythm control, atrioventricular node (AVN) ablation followed by ventricular pacing "ablate-and-pace" offers reliable rate control and symptom relief. Conventional transvenous systems are effective but associated with lead- and pocket-related complications. Leadless pacemakers represent a promising alternative, yet comparative data in this setting remain scarce. The aim is to compare clinical outcomes of leadless versus transvenous single-chamber pacemakers in patients undergoing AVN ablation for permanent AF. Methods We conducted a retrospective, multicenter study (LEAD-AP) of 168 consecutive patients undergoing ablate-and-pace between 2017 and 2024 across four European centers. Patients received either a leadless pacemaker (n=56) or a conventional transvenous VVI pacemaker (n=112). The primary efficacy endpoint was the composite of all-cause mortality, cardiovascular mortality, AF-related hospitalizations, unplanned visits and device-related hospitalizations or reinterventions. The secondary efficacy endpoint was device-related hospitalizations or reinterventions. The primary safety endpoint was acute complications within 30 days. Results Patients in the leadless group more frequently underwent a single-step ablate-and-pace strategy (96.4% vs 10.9%, p<0.001), resulting in shorter hospitalization (1.1 days ± 3.1 vs 5.7 days ± 2.2, p=0.008). At 24 months of follow-up, there was no statistically significant difference between patients with leadless pacemaker vs standard single-chamber VVI pacemaker in the event-free survival for the primary clinical efficacy endpoint (82.1 % vs 80.4 % Log-Rank p = 0.29), Figure 1 and 2. Conclusions Leadless pacemakers provide comparable safety and efficacy to transvenous systems in ablate-and-pace patients, while enabling shorter hospitalization through a streamlined single-step approach.Figure 1Figure 2
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Overeinder et al. (2026) conducted a cohort in Permanent atrial fibrillation (n=168). Leadless pacemaker vs. Conventional transvenous VVI pacemaker was evaluated on Composite of all-cause mortality, cardiovascular mortality, AF-related hospitalizations, unplanned visits and device-related hospitalizations or reinterventions (p=0.29). Leadless pacemakers provided similar 24-month event-free survival for the primary composite endpoint compared to transvenous pacemakers (82.1% vs 80.4%, p=0.29).
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