Safety and feasibility of leadless pacemaker implantation in elderly small-framed asian patients: a multicenter retrospective study

Background Leadless pacemaker (LPM) therapy eliminates pocket- and lead-related complications of transvenous systems, however its large delivery sheath may raise safety concerns in small-framed elderly Asian patients. Data in this population remain scarce. Aim To assess the procedural safety, feasibility, and short-term outcomes of LPM implantation in elderly Asian patients, and to compare them with transvenous single-chamber pacemakers (TV-PM). Methods We retrospectively analyzed 149 consecutive patients (90 LPM, 59 TV-PM) aged ≥80 years who underwent pacemaker implantation at three Japanese centers between 2010 and 2021. Primary endpoints were procedural safety and feasibility. Secondary endpoints included all-cause mortality, heart-failure hospitalization, and device-related complications within 2 years Results Median age was 90 [83–94] vs 84 [83–95] years; mean height 148.8 ± 9.7 vs 155.8 ± 12.2 cm, confirming a smaller body habitus in this Asian cohort. LVEF was similar (60.0% vs 64.5%, p = 0.16), but renal dysfunction was more common in TV-SPM (76.3% vs 46.7%, p < 0.001). All implantations were successful. Despite frailty and smaller anatomy, LPM procedures were shorter (55.7 ± 25.8 vs 78.5 ± 15.8 min, p = 0.008) and required fewer prolonged hospitalizations (>48 h beyond plan: 48.9% vs 64.4%, p = 0.05). Major complications were infrequent and comparable (5.6% vs 11.9%, p = 0.14). Conclusion LPM implantation is safe and feasible even in frail, small-framed Asian octogenarians. These findings suggest that LPM can overcome anatomical and procedural limitations of transvenous systems, supporting broader adoption in aging Asian populations.