Clinical Outcomes of Non-Atrial Fibrillation Bradyarrhythmias Treated With a Ventricular Demand Leadless Pacemaker Compared With an Atrioventricular Synchronous Transvenous Pacemaker　― A Propensity Score-Matched Analysis

• Published in: Circulation Journal 2022/07/25, Vol.86(8), pp.1283-1291
• Main Authors: Sasaki, Kenichi, Togashi, Daisuke, Nakajima, Ikutaro, Suchi, Taro, Nakayama, Yui, Harada, Tomoo, Akashi, Yoshihiro J
• Format: Article
• Language: English
• Subjects: Atrioventricular Block - etiology; Atrioventricular Block - therapy; Bradycardia - therapy; Cardiac Pacing, Artificial - methods; Clinical outcome; Follow-Up Studies; Heart failure; Heart Failure - etiology; Humans; Leadless pacemaker; Pacemaker, Artificial - adverse effects; Propensity Score; Retrospective Studies; Tricuspid valve
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-21-0889

Background:Implanting a ventricular demand leadless pacemaker (VVI-LPM) for patients with non-atrial fibrillation (AF) bradyarrhythmias such as sick sinus syndrome (SSS) or high-grade (i.e., second- or third-degree) atrioventricular (AV) block is not recommended unless they have limited vascular access or a high infection risk; nevertheless, an unexpectedly high number of VVI-LPM implantations have been performed. This study investigated the clinical outcomes of these unusual uses.Methods and Results:This study retrospectively analyzed 193 patients who were newly implanted with a VVI-LPM or an atrioventricular synchronous transvenous pacemaker (DDD-TPM) for non-AF bradyarrhythmias at a high-volume center in Japan from September 2017 to September 2020. Propensity score-matching produced 2 comparable cohorts treated with a VVI-LPM or DDD-TPM (n=58 each). Each group had 20 (34%) patients with SSS and 38 (66%) patients with high-grade AV block. During a median follow up of 733 (interquartile range 395−997) days, there were no significant differences between the VVI-LPM and DDD-TPM groups regarding late device-related adverse events (0% vs. 4%, log-rank P=0.155), but the VVI-LPM group had a significantly increased readmission rate for heart failure (HF) (29% vs. 2%, log-rank P=0.001) and a tendency to have higher all-cause mortality (28% vs. 4%, log-rank P=0.059).Conclusions:The implantation of a VVI-LPM for non-AF bradyarrhythmias increased the incidence of HF-related rehospitalization at the mid-term follow up compared to the use of a DDD-TPM.