Does leadless pacemaker implantation reduce complications and mortality compared to transvenous pacemakers in patients requiring permanent pacing after TAVR?
In patients requiring permanent pacing after TAVR, leadless pacemakers reduce device and vascular complications but are associated with higher all-cause mortality compared to transvenous pacemakers.
Abstract 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; p0.004) 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.
Carvalho et al. (Mon,) studied this question.