Heart failure & cardiomyopathies
Incidence, Modifiable Risk Factors, and Management of Cardiomyopathy After Ventricular Leadless Pacemaker Implantation
Authors' conclusion
Cardiomyopathy occurred in a substantial proportion of LPM recipients. RVOT implantation was associated with lower cardiomyopathy incidence and slower LVEF decline, whereas Micra AV implantation did not improve clinical outcomes. However, higher AV synchrony was linked to slower LVEF deterioration.
Study context
- Population
- Patients implanted with a leadless ventricular pacemaker (LPM) between July 2015 and March 2025patients implanted with an LPM
- Participants
- 401 patients
- Exposure
- RVOT vs mid-septal implantation; Micra AV vs VR
- Micra AVn = 145
- Outcome
- All-cause cardiomyopathy (≥10% LVEF decline to <50%)
- Follow-up
- Median 33.0 months
Main finding
As reported in the abstract
All-cause cardiomyopathy
13.6%
4.8%/year
Observational data: associations, not effects.
Further findings
| Outcome | RVOT implantation | Mid-septal implantation | HR | P value |
|---|---|---|---|---|
| All-cause cardiomyopathy by implant siteRVOT implantation vs mid-septal implantation · independently associated with a lower incidence | 0.48 | P = 0.019 | ||
| LVEF decline by implant site | −0.56%/year | −1.43%/year |
- LVEF decline by implant site: slower LVEF decline with RVOT, P=0.013
Pacing-induced cardiomyopathy (PICM) · median follow-up of 33.0 months
- PICM
- 5.5% (1.9%/year)
Clinical outcomes and LVEF evolution by device type
- Device type (Micra AV vs VR) was not associated with clinical outcomes or LVEF evolution
Management among patients developing cardiomyopathy
- Medically treated, of patients developing cardiomyopathy
- 92.7%
- ≥10% LVEF improvement, of patients developing cardiomyopathy
- 57.9%
- Complete recovery, of patients developing cardiomyopathy
- 36.8%
- CRT upgrade, of patients developing cardiomyopathy
- 7.3%
Original publication
Incidence, Modifiable Risk Factors, and Management of Cardiomyopathy After Ventricular Leadless Pacemaker Implantation. Heart Rhythm. Published 21 October 2026. doi:10.
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