Headless Pacemaker in Bradyarrhythmia After Transcatheter Aortic Valve Replacement: A Meta-Analysis

Leadless pacemaker (LPM) offers a favorable safety profile for bradyarrhythmia, especially in patients at high risk for infection from transvenous pacemaker (TPM). However, its use for bradyarrhythmia after transcatheter aortic valve replacement (TAVR) remains unexplored. We conducted a systematic search from the inception of PubMed to November 2025. Eligible studies included adults who received a pacemaker after TAVR. Primary endpoints were overall complications and device-related complications. Secondary endpoints included all-cause mortality, device-related mortality, hospitalization for heart failure, procedure time, fluoroscopy time, and length of stay after pacemaker implantation. We included a total of 11 studies involving 11,750 patients who underwent TAVR (1243 with LPM and 10,507 with TPM). None of the patients in the LPM group experienced device-related complications, with significantly lower rates compared to the TPM group adjusted hazard ratio (aHR) 0.35, 95% confidence interval (CI): 0.13–0.97; I 2 = 0%. Similarly, no device-related mortality was observed in the LPM group. All-cause mortality and hospitalization for heart failure were comparable between the LPM and TPM groups (aHR 1.02, 95% CI, 0.05–20.68; I 2 = 25% and aHR 0.87, 95% CI, 0.24–3.17; I 2 = 0%, respectively). The feasibility of LPM was also similar to TPM in terms of procedural time (MD −28.66 minutes, 95% CI, −92.36 to 35.03; I 2 = 11%), fluoroscopy time (MD −1.36 minutes, 95% CI, −6.30 to 3.59; I 2 = 0%), and length of stay (MD −0.53 days, 95% CI, −1.33 to 0.27; I 2 = 6%). In conclusion, LPM could serve as a first-line pacing strategy in bradyarrhythmia post-TAVR due to its safer profile with comparable efficacy and feasibility to TPM.