Leadless Permanent Pacing: A Single Centre Australian Experience

Background: To describe the performance and clinical outcomes of consecutive patients having a leadless pacemaker (LP) implanted at a single institution. Methods: Clinical data and device parameters were prospectively collected on all patients undergoing LP implantation from November 2015 to April 2018. Results: A total of 79 patients (52 male), median age of 78 years, were included. Leadless pacemaker implantation was successful in 76 patients (96%). Implantation failed in two patients due to excessive venous tortuosity and due to inadequate sensing in another. Seventy-three patients (96%) had chronic atrial fibrillation and all had a Class I or II indication for pacing. Procedure time was 29 minutes (IQR 21–43) and fluoroscopy time was 8 minutes (IQR 5–13). The median R wave at implant was 11.2 mV (IQR 6.9–15.0). The median capture threshold at 0.24 ms was 0.5 V (IQR 0.4–0.9) and impedance was 754 Ω (IQR 680–880). Intraprocedural acute dislodgement occurred in one patient following cutting of the tether but successful snaring and reimplantation was performed. During a median follow-up of 355 days (range 9–905), overall electrical performance has been excellent. No patients have been readmitted for device revision or complications. Five patients (7%) died during follow-up from unrelated causes. Conclusions: Leadless pacemakers can be implanted safely and effectively in the majority of patients. Device electrical performance was excellent over a median follow-up of 12 months.