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July 4, 2026Pacing and Clinical Electrophysiology

Leadless Pacemaker Implantation in High‐Risk Patients: Real‐World Outcomes From a Multicenter Israeli Registry

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Why the study?

Transvenous pacemakers carry significant complications, and data on leadless pacemakers in high-risk patients ineligible for transvenous systems remain limited.

Does leadless pacemaker implantation provide safe and effective pacing in high-risk bradyarrhythmia patients unsuitable for transvenous pacing?

Population

138 high-risk bradyarrhythmia patients unsuitable for transvenous pacing across four Israeli hospitals

Comparison

Leadless pacemaker implantation

Design

Retrospective observational multicenter registry

Follow-up

12 months

Key result

Leadless pacemaker implantation in high-risk patients achieved a 98% procedural success rate, with a 1-year cumulative complication rate of 4.7% and all-cause mortality of 12.3%.

Authors

MKMoshe KatzBar-Ilan UniversityMVMarianna VanderHebrew University of JerusalemDLDavid LuriaHebrew University of Jerusalem

Discussion

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Overview

Supports feasibility in high-risk patients ineligible for transvenous pacing; leaves open need for prospective trials to confirm outcomes.

Key Points

  • To evaluate the outcomes of leadless pacemakers in high-risk patients not suitable for transvenous pacing.
  • Retrospective, observational registry across four Israeli hospitals.
  • Patients included those with venous abnormalities, device infections, or high infection risk, undergoing implantation from July 2021 to December 2022.
  • Outcomes assessed included procedural success, complications, electrical performance, and mortality at multiple time points.
  • Procedural success rate was 98% with Micra devices.
  • Acute complications occurred in 2.9%, with 2.2% mortality within 48 hours and a 1-year cumulative complication rate of 4.7%.
  • 1-year all-cause mortality rate was 12.3% with stable electrical performance and low pacing thresholds.

Study Design

Type

Observational (n=138)

Multicenter

Yes

Structured PICO

Does leadless pacemaker implantation provide safe and effective pacing in high-risk bradyarrhythmia patients unsuitable for transvenous pacing?

P
Population
138 high-risk patients with bradyarrhythmia unsuitable for transvenous pacing who underwent leadless pacemaker implantation, followed for 12 months.
E
Exposure
Leadless pacemaker implantation
O
Outcome
Procedural success, complications, electrical performance, and mortality assessed at 48 h, 30 days, and 12 monthssafety

Leadless pacemaker implantation is a safe and effective alternative with high procedural success and low complication rates in high-risk patients unsuitable for transvenous systems.

Cite This Study

Katz et al. (2026) conducted an observational in High risk bradyarrhythmia unsuitable for transvenous pacing (n=138). Leadless pacemaker implantation was evaluated on Procedural success. Leadless pacemaker implantation in high-risk patients achieved a 98% procedural success rate, with a 1-year cumulative complication rate of 4.7% and all-cause mortality of 12.3%.

synapsesocial.com/papers/6a48a5c889561a0c2d78e4bahttps://doi.org/10.1111/pace.70333
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