Key result
In patients with end stage renal disease, leadless pacemakers were associated with higher odds of cardiac complications compared to transvenous pacemakers (aOR 4.12; 95% CI 1.70-9.98; p<0.01).
Why the study?
Leadless pacemakers provide a safe and effective alternative pacing strategy, but limited data exist regarding their use in patients with ESRD.
Does leadless pacemaker implantation reduce complications, mortality, or readmissions compared to transvenous pacemaker implantation in adult patients with end stage renal disease?
Cohort (n=7,865)
Yes
Does leadless pacemaker implantation reduce complications, mortality, or readmissions compared to transvenous pacemaker implantation in adult patients with end stage renal disease?
Odds Ratio: 4.12 (95% CI 1.7–9.98)
p-value: p=<0.01
In patients with end stage renal disease, leadless pacemakers are associated with higher short-term in-hospital complications and healthcare utilization compared to transvenous pacemakers, with no difference in short-term mortality or 30-day readmissions.
Leadless pacemakers were associated with higher complications in ESRD; leaves open whether randomized trials would change device selection.
Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32–2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40–9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70–9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions.
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Kansakar et al. (2025) conducted a cohort in End Stage Kidney Disease (n=7,865). Leadless pacemaker vs. Transvenous pacemaker was evaluated on Cardiac complications (aOR 4.12, 95% CI 1.70-9.98, p=<0.01). In patients with end stage renal disease, leadless pacemakers were associated with higher odds of cardiac complications compared to transvenous pacemakers (aOR 4.12; 95% CI 1.70-9.98; p<0.01).
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