Arrhythmias & electrophysiologyCohort study
Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement
- Retrospective cohort study
- propensity score overlap weighting
Authors' conclusion
Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
Study context
- Population
- Medicare fee-for-service beneficiaries aged ≥65 years with pacemaker following transcatheter aortic valve replacement (TAVR), 2017–2020
- Participants
- 10,338 beneficiaries
- Exposure
- Leadless vs transvenous pacemakers after TAVR
- Leadlessn = 730
- Transvenousn = 9,608reference
Main finding
As reported in the abstract
In-hospital overall complications · in-hospital
P = 0.014
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| All-cause death · midterm (up to 2 years) | adjusted HR 1.13 (95% CI 0.96–1.32) | P = 0.15 | |
| HF hospitalization · midterm (up to 2 years) | subdistribution HR 0.89 (95% CI 0.74–1.08) | P = 0.24 | |
| Infective endocarditis · midterm (up to 2 years) | subdistribution HR 0.98 (95% CI 0.44–2.17) | P = 0.95 | |
| 0.512Ratio (log scale) |
Trend in leadless pacemaker use after TAVR, 2017–2020
- Increase in proportion of leadless pacemakers
- 3.5-fold
Safety
| Outcome | subdistribution HR (95% CI) | P value | |
|---|---|---|---|
| Device-related complications · midterm (up to 2 years) | 0.37 (0.21–0.64) | P < 0.001 | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
Original publication
Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. Published 17 July 2024. doi:10.1016/j.jcin.2024.05.030
Summarised from the published abstract; every number is checked against it