Objective Unlike transvenous lead pacemakers (TVPs), leadless pacemakers (LPs) do not require a subcutaneous pocket in the chest or transvenous lead. This makes LPs a favorable option, particularly for elderly patients. However, clear criteria have not yet been established for choosing between TVP and LP. Therefore, we investigated short-term postoperative outcomes in elderly patients who underwent permanent pacemaker implantation. Methods This retrospective single-center study reviewed the medical records of 149 consecutive patients who underwent permanent pacemaker implantation at Daido Hospital (Nagoya, Japan) between January 2020 and December 2023. We reviewed the patients' backgrounds and evaluated the perioperative complications and clinical outcomes. Results Among 149 consecutive patients who underwent permanent pacemaker implantation, we identified 84 patients ≥80 years old, comprising 42 who received LPs and 42 who received TVPs, for inclusion in the analysis. The Clinical Frailty Scale showed significantly more advanced frailty in patients with LP than in patients with TVP (4.0 vs. 3.0). Procedure-related complications occurred in only one LP patient who required reimplantation due to dislodgement immediately after release. In contrast, four patients with TVP experienced complications such as cardiac tamponade, pneumothorax, and atrial lead dislodgement. There was no significant difference in the incidence of postoperative heart failure between the two groups. Deaths attributed to infection, malignancy, or senility were more common in the LP group than in the TVP group, with no cardiac-related deaths. Conclusion LP implantation is comparable with TVP implantation in terms of perioperative complications and short-term outcomes. Patient age, especially the degree of frailty in older adults, might serve as an important clinical indicator for selecting an appropriate pacemaker.
Otsuka et al. (Wed,) studied this question.