Safety of Leadless Pacemaker Implantation in the Very Elderly.
BACKGROUND:The MicraTM leadless pacemaker (MLP) has proven to be an effective alternative to a traditional transvenous pacemaker (TVP). However, there has been concern about using the MLP in frail, elderly patients due to the size of the implant sheath and perceived risk of perforation. OBJECTIVE:To report the safety of the MLP and compare it to TVPs in the very elderly. METHODS:All patients ≥ 85 years old who received an MLP or a single chamber TVP across six hospitals in the Northwell Health system from 12/2015 to 11/2019 were included. Demographics, procedural details and procedure-related complications were reviewed. RESULTS:Over four years, 564 patients underwent MLP implantation. During this time 183 MLPs and 119 TVPs were implanted in patients ≥ 85 years old. The mean age was 89.7±3.4 years and 47.4% were men. MLP implantation was successful in all but three patients (98.4% success rate). There was no difference in procedure-related complications (3.3% vs. 5.9%, p=0.276). Complications included: five access site hematomas in the MLP group, three in the TVP group, one pericardial effusion in each group and three acute lead dislodgements (<24 >hours) in the TVP group. MLP implantation resulted in a significantly shorter mean procedure time (35.7±23.0 mins vs 62.3±31.5 mins, p<0.001). CONCLUSION:In a large, multicenter study of patients ≥ 85 years old, MLP Implantation (1) was successful in 98.4% of patients, (2) safe with no difference in procedure-related complications compared to the TVP group and (3) resulted in significantly shorter procedure times.